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PERMITME NAME/ADDRESS (7,w&i ForthrrNw?L«.n°n IIDI0rr+w1 <br />NAME <br />ADDRESS <br />0. BOX I E17 <br />IG CO 816 <br />FACILITY PER MINE <br />LOCATION CO 816 <br />.110ND G- DU BOIS, PRES/GM <br />NATIONAL POLLUTANT OISCHAROE ELIMINATION SYSTEM (NPOES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHAROE NUMBER <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 JC ) <br />F - FINAL MOFP <br />POND TO WEST PYEATT GULCH <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREOUENcY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ###### ### #at s: 6 `• # rtiE#it : ?. O 771 :TL <br /> REQUIREMENT '- = M I N 11`1UI i MAXIMUM S' <br /> SAMPLE ;: +r <br /> MEASUREMENT <br />_ PERMIT # # y ;- : f # ## OPT ONAL. ' :?. 5 <br />U1:: REQUIREMENT 30DA A VG A I LY I.1 Y, PIONT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT #1F?FiF## -`iF##### z' :. ### iF# <br />' 1 <br />04 ONT s <br /> REQUIREMENT # s 1 MAX GENT <br /> SAMPLE <br /> } <br />J <br />p: MEASUREMENT <br />0 PERMIT REF ii I I <br />'?I-.1v • _ ' ?r ;` iEiF#iF3t #SF##il # <br /> REQUIREMENT 0VA A', `` <br />DA I E! ` MX <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> <br />Q <br />REMENT <br /> <br />340VA AVC <br />Lf'r <br />DAILY <br />11X <br />_ <br /> UI <br />RE 1 <br />t' SAMPLE <br /> MEASUREMENT <br /> PERMIT 77 <br />.. ) : REQUIREMENT rC , <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />TLE PRINCIPAL EXECUTIVE OFFICER t femlr order pen' ty ° Is. that this document end sit .nachmants were TELEPHONE <br />A <br />T <br />DATE <br />prepared under my direction w superetslon In accord.nce with . system deatgned <br />ME/ <br />I <br />N <br />to enure that quallned personnel properly Col1wr and evaluate the Inronnatlon <br />111 r; Il j l _ ' sobmltird- Based on my Inquiry of the person or person. who manse the system, <br />' or those penmo directly reeponsib4 for gathering the Information, the Inrormatlon <br />_ submitted b• to the befit of my Anewkdge and better. Ins. accurate. and complete. <br />SIGNATURE OF PRINCIPAL EXECUTNE <br />tn <br />d <br />t <br />k <br /> a- that therv see <br />gn <br />can <br />penue <br />s for Nbmttnnr raise Infornsadon, <br />TYPED OR PRINTED ? Indudlrq The possibility of nne and lmprlsonment for knowing Wstlo OFFICER OR AUTHORIZED AGENT CODE NUMEiER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference aH attachment: here) <br />PL>` "C1l IDS LIMIT APP!.-TED FOP "=IOYRr'4HP PPFhTP EVENT- <br />i I NG =ASE <br />M -lhi , Hi A? p.: f 'f 1Ft i. ?- <br />EPA Form 3320-1 (Rev. 3M) Previous editions may be used. form PAGE 'OF/