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PERMITTEE NAME/ADDRESSQ-&&faewyN..?L«wiat(/D(Oimwn) <br />NAME <br />ADDRESS <br />DUX 187 <br />IG CO 8162! <br />FACILITY PER MINE <br />LOCATION ;G CO 8162! <br />..imnnln n nil nnTc:z. PAFc?/marl <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM /INPOESI <br />DISCHARGE MONITORING REPORT IDMRI <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM - TO <br />OM9 - <br />MI <br />F ' <br />PDI <br />NOTE: Read kntructione before completing this tam. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, <br /> <br /> <br />EX FREQUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br />-: PERMIT ###3i# REPORT ;:###: ;:##t, ###xrt 1IdCi?: )i' <br /> REQUIREMENT I NST MAX MONT: . <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />r <br /> PERMIT <br /> REQUIREMENT l y <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 />NAMEfnTLE PRINCIPAL EXECUTIVE OFFICER I Cen"y under F na ly 0 I.w that this dotvmrm and w .ttachmenb wen <br /> <br />TELEPHONE <br />PRPared under my direction or mper.hton In ateord.rwe wlth a system designed . <br /> <br />DATE <br />to Inure that qu llBed perwnnel pnoperiy 9011W and tsatuale the inrrermlbn <br />I i'.. -,• ?/ sobmItted. Dowd on my Inquiry *(o* Penon of peeUMS he manage the rystern, f . <br />f <br />or those persons directly msporedW <br />or gathering the Intermatlos. the Inrornatlon <br />f <br />• r •, <br />- <br />/ <br />- <br />submllled K to the beet o <br />my knowiedge end belW. trw, arcuate, end tornplete _ <br />'Wil <br />SIGNATURE OF PRINCWAL EXECUTIVE <br />-- I <br />th <br />t th <br />r <br />i <br />k <br />t <br />ltl <br />r <br />bmlttin <br />fair inf <br />ti <br />; /, <br /> am swan <br />ere a <br />e s <br />g <br />c <br />a <br />peoe <br />or s" <br />g <br />orma <br />on. <br />a <br />ee AKA <br />TYPED OR PRINTED Inehrding the possibility or Bne and imprbom lint For knowing ctolallorm OFFICER OR AUTHORIZED AGENT COA NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference an attachments herel <br />ABLE SOLIDS LIMIT APPLIED FOR C=10YR,24HR PRECIP EVENT- <br />DS MONITORING - I . B 2. <br />EPA Form 332¢1 (Rev. 3/99) Previous editions may be used. 00 1 96 / {: 15434-pa)ifflrm.