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pERMITTEE NAME/ADDRESS (7--U . Forwy Mo.?L«r/ew 1/D(efmne) <br />NAME <br />ADDRESS - '•1 I NES <br />j. BOX 535 <br />:1ERSET CO 8143 <br />FACILITY -,4B0RN CRK & ELK CRK MINES <br />LOCATION 1ERSE'T' CO 8143' <br />aMFS T conPFR. FXFC. V P <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM INPOES1 <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved. <br />OMB No 20404dO4 <br />MINOR <br />(SUER MH) <br />F - FINAL <br />. D I MEET POND TO ELK <br />t. <br />NOTE: Read k»tructiom before complet" thle Iorm. <br />iuNIS <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO <br /> <br />EX FR[('U <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT REPORT s: '_. ?; -###?t t Itr. r ttf NCt./ /I AI <br /> REQUIREMENT INST MAX MON. ? <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> <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 />NAMElTITLE PRINCIPAL EXECUTIVE OFFICER i mro > under penalty ow that this, dorunurnt and au attachments were TELEPHONE DATE <br />prepared under my dlrertlon or nrprrvMon In accordance with a system ddgmud <br />to aseamre that qusllntd personnel property gather and evahmate the Information <br />sobmilled <br />Bawd cm my Inquiry of the peroo or peracca who mana <br />e the s <br />stem <br />. <br />g <br />y <br />, _ <br />- o <br />dl <br />omibk f <br />th <br />dl <br />te, <br />th <br />i <br />I <br />fet d <br />th <br />i <br />r <br />% ' • i <br />th <br />k <br />r <br />eta, persons <br />re <br />r <br />p <br />or ga <br />er <br />ng <br />e <br />n <br />oet, <br />e <br />n <br />ormat <br />m <br />th <br />b <br />kn <br />d b <br />b <br />d i <br />I <br />f m <br />wl <br />d <br />r <br />" <br />o <br />o <br />ge an <br />.. su <br />mitte <br />s, to <br />e <br />y <br />e <br />ette <br />, true. accurate, and cormpkle. <br />SIGNATURE OF ?RINCt?Al EXECUTIVE <br />?- - i a <br />r <br />t th <br />re <br />l <br />rdfl <br />t <br />en <br />ltie <br />f <br />b <br />ltti <br />f <br />I <br />f <br />th <br />l <br />i <br /> m awa <br />e <br />a <br />em a <br />g <br />can <br />p <br />a <br />s <br />or ro <br />m <br />n <br />s <br />ng <br />a <br />se <br />ormat <br />on. J A A <br />TYPED OR PRINTED Imciuding the pondbllltr or nee and Imprlsonmrmt for knowing viol¦tlaa OFFICER OR AUTHORIZED AGENT CODE NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANA I lvn yr Ptfv r vtvt.^ I Ivrna irrereience an errecnmenra ne7er <br />_ F":',BLE SOLIDS LMT APPLIED rOP "-10YP: 24r-IR PP.FCTr' r-, 7: <br />E'• } A. 1, <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. 11, t!n - -? This IS a 4-part fOrn1 PAGE OF '