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pERMITTEE NAti s(1nchuie swvhry Nae?Laewra l/Dldlrewel) <br />NAME <br />ADDRESS <br />Li. LJ i 483 <br />•.7NIA CO 8142 <br />FACILITY W I E 1,40 2 MINE <br />LOCATION'-' :=+1JN I A CID 8142 <br />siLLlAln A. BEAR JR., MINE MGR <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM fINPOE3I <br />DISCHARGE MONITORING REPORT IDMRI <br />PERMIT NUMBER ascl+AnOE NuMeER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved. <br />OMB No. 2040-0004 <br />MINOR <br />(SUBR MH) <br />>: - FINAL <br />CHRONIC WET TESTING FOR 006A <br />NOTE: Road Instructiorw before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. <br /> <br />EX RtEOUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT : REPORT :##r r ;f###IF# <br /> REQUIREMENT SI NGSAMP <br />,')Pt, SAMPLE . <br /> MEASUREMENT f, <br /> PERMIT #if?r # #?t# 100 t?tt#?t## <s ?Ii -iRLY '12"l <br /> REQUIREMENT MN VALUE <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT #### #'?#3E 9t9tr REPORT <br />###kiE# <br />##### <br />L <br />I F <br /> REQUIREMENT SIN© SAMP <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT 3Eif i1 #9F9F'? ;' 200 ###### ##### ' F?.Y {11•-;a_ <br />LEL0V. REQUIREMENT MN VALUE_ <br /> SAMPLE <br />ar' til'J 1 A CHR (' MEASUREMENT <br />;.n PERMIT s h REPORT <br />rillifn <br /> REQUIREMENT S I NGSA111F' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT REPORT <br /> REQUIREMENT SINOSAMP _ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - <br />REPORT <br /> REQUIREMENT SI NGSAMP <br /> <br />NAME/TTTLE PRINCIPAL EXECUTIVE OFFICER 1 eertuly under penalty o law IMt thb do rnenl and on ¦Ilachm <br />prspared under my direction or suuper•islon in accordance with ents were <br />a system designed <br />TELEPHONE <br />DATE <br /> 1e mumrs (hall qualified personnel PioPeAy gather and eealrate the Infoetnatlon <br />submitted. Dowd on my inquiry *(the person or persona who manage the f"tem. <br />_ <br /> or those prrsaas directly responsible for gathering the Information, the Information _ <br /> submllled Is, to the beat of my knowWge and belief, true, accurate, and complete. <br />t th <br />e <br />l <br />dnc <br />fn <br />1 <br />th <br />t <br />f <br />b <br />I <br />f <br />d <br />SIGNATURE OF PRINCEPAL EXECUTIVE <br /> a <br />er <br />are a <br />gr <br />aa <br />pena <br />es <br />am a.¦- <br />or su <br />mitting rave <br />n <br />orma <br />on, REA <br />TYPED OR PRINTED Including the po alblllly of flat and ImpAsonment for knowing Aolauorn OFFICER OR AUTHORIZED AOENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference sM attachments hers) <br />.J T RESULTS OF LETHALITY DER I VS AS " FFf--1-CT" . ^F'ril•)-r ! A.h.n <br />•,T WHICH STATISTICALL_'r ?IGNIc. t> <br />t r1r, U :l 1 ll/l Ti4t i_t Ti1Y RPT 1 CjRM 1- <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. - T)*s-,is a 4-paq jgrm. PAGE OF