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KAMITTEE NAME/ADDRESS(Ync46FwdmyNarrLwation4(DWWv-) <br />NAME <br />ADDRESS <br />J. BOX 535 <br />I•1ERSET CO <br />FACILITY k. -JBORN CRK $ ELK CRK MINE <br />LOCATION --IERSET CO <br />=i,MES T. COOPER, EXEC V. P <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPOESI <br />DISCHARGE MONITORING REPORT ID R) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved. <br />OMB No. 2040-OOQ4 <br />MINOR <br />(SUBR MH) <br />F - FINAL <br />SURF RIJNOFF TO N F K GUI-41S RI' <br />NOTE: Read kwtrucdorka before complet" this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, <br /> <br />EX FREOUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE :. t ` .; . <br /> MEASUREMENT <br /> PERMIT ### ae#it REPORT 'NCB/ V T - <br /> REQUIREMENT I NST MAX MONTH <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />NAME/T1TLE PRINCIPAL EXECUTIVE OFFICER i rimi5 " r Pen, y o f.w that this docu it and all atlachmenb wen TELEPHONE <br />l <br />d <br />d <br />i <br />i <br />t DATE <br />un <br />si <br />prepare <br />er my d <br />rect <br />on w ulp- <br />on In accordance wflh a system designed <br />to swum that <br />ualified <br />ertwnnel <br />ro <br />ert <br />athe <br />nd <br />v <br />l <br />t <br />th <br />I <br />form <br />ti <br />q <br />p <br />p <br />p <br />y g <br />r a <br />e <br />a <br />ua <br />e <br />e <br />n <br />on <br />a <br />submitted. Bawd on my inquiry of the person or person who manage the system <br />- - <br />I or these persona directly reponsibie for gathering the Information, the information <br />y -• <br />t <br />- <br />b <br />h <br />f <br />k <br />d <br />- <br />• <br />i , J <br />my <br />w <br />mitled Is, to t <br />e be <br />o <br />nowle <br />ge and better, trot, sccunle, and complete. <br />- <br />1 .m <br />sl <br />ninrent <br />SIGNATURE OF PRINCNAL'FxFc fT" / <br />w <br />th <br />t th <br />a <br />en <br />lde <br />bmitn <br />te I <br />fl <br />f <br />r ? <br /> g <br />a <br />an <br />a <br />ere <br />re <br />p <br />s <br />or wr <br />ng <br />a <br />oe. <br />s <br />n - AREA <br />TYPED OR PRINTED Including the possibility of nr.r -d imprisonment for knowing vlotatlons OFFICER OR AUTHORIZED AGENT NUMEfER <br />CODE YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS /Reference DIN attachments hare/ <br />r 1-A£aL_c t±? IDS LM-T !'-,PF'I--TED FOR =10YR ..•:; <br />• -iR VENT-SEE I 1, PP 4-t_ I <br />EPA Form 3320.1 (Rev. 3/99) Previous editions may be used. TtuS JS 4 _-Kart form. PAGE OF <br />',1'J 1 rrt.1J t_