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PERMITTEE NAME)ADDRESS(/neIt&F.- lryNaaa?L oom(/D(dfww) <br />NAME <br />ADDRESS <br />J. BOX 167 <br />t,iiA1G CO 8162c <br />FACILITY T^APPER MINE <br />LOCATIDN i I G CO 8162-r <br />"?YMOND G. DU BOIS, PRFS/GM <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES) <br />DISCHARGE MONITORING REPORT (D R) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />MINOR <br />(SUBR JC) <br />F - FINAL <br />POND #1 TO UTE GULCH <br />Form Approved. <br />OMB No. 2040-0004 <br />NOTE: Read instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, <br /> <br />EX FREQUENCY <br />OF SAMPLE <br /> ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT 3t-#iE*41 ; REPORT ## ##?r #### ####:r?s C ,, A' <br /> REQUIREMENT I NST MAX MON i _ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE J ! ' <br /> MEASUREMENT <br /> PERMIT i <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 /> <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECI TTVE OFFICER ' "^"rantler penalty ° I.. that Uti document .red ati .ttacn"w"l. wr a TELEPHONE <br />prepared under my direction or super.kelon In accordance with • sratem designed - f' DATE <br />_ TO aaure that go.Afled prrwnnel propeAl Lalhe and evaluate the Information <br />f°bmilted. Bawd tm m) Inquiry of the Person or persona who tnarsar IM ryatem, . <br />enom direcrl <br />m <br />onsdbk for <br />alberln <br />or those <br />th <br />I <br />f <br />r <br />tl <br />th <br />I <br />l <br />lb <br />-?- <br />- <br />• <br />f <br />p <br />j <br />B <br />p <br />e <br />n <br />o <br />ms <br />oe4 <br />e <br />n <br />orma <br />n <br />- <br />submitted ke <br />to the bal of my knowledge and base f <br />true <br />atcvrale <br />and <br />l <br />t <br />• <br />, •? ?/ <br />/ <br />. <br />. <br />. <br />. <br />comp <br />e <br />e. <br />? <br />I am aware that there are significant penaltlee for asrbrrYtdng faker Information <br />SIGNATURE OF PRINC311"AL EXECUTIVE , <br /> . <br />Inrtudin <br />th <br />ibl111 <br />nd I <br />f fl <br />f ARE <br />TYPED OR PRINTED g <br />e pnaa <br />oe a <br />mp Asorlmrnl <br />r o <br />or knowing elolaUom OFFICER OR AUTHORIZED AGENT ODE NUMBER <br />C YEAR MO DAY <br />COMMENTS AND EXPLA rd Al I ivn yr nn r vl%jLp% 1 tvrga frfsrsrsncs on srracnmsnrs nsrsf <br />-ABLE SOL <br />- 70S MONIT <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. <br />LIMfT APPLIED FOR =10YR,24HR PRECIP FVENI <br />IG - I. B. 2. <br />0015b i - I'llu3_i6?4-pfOrm.