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PERMITTEE NAME/ADDRESS pa&y F- yN..?Loewloml(D( mW) <br />NAME <br />ADDRESS <br />_). BOX 187 <br />CRAIG CO 8162 <br />FACILITY ' `?APPER MINE <br />LOCATION - -? I G CO 8162 <br />)YMOND G. DU BOIS, PRES/GM <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEIN //NPOE$) <br />DISCHARGE MONITORING REPORT (DMRI <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved. <br />OMB No 2040-0004 <br />MI <br />(S NOR <br />UBR <br />JC) <br />F - FI NAL MOFAI <br />DI SCHA RGE TO GROUSE GULCH <br />NOTE: Read Instruction before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. <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 #aE# 6 5 ###it f - ?. O EFI?. _ <br /> REQUIREMENT MINIMUM MAXIMUM <br /> SAMPLE <br /> MEASUREMENT <br />1. i PERMIT #r##u #### `=' ### OPTIONAL O. 5 1VCE/ <br />N ; GPOIL REQUIREMENT 30DA AVG DAILY MY .. MONT <br />A,, _ SAMPLE i... s <br /> MEASUREMENT <br /> PERMIT iFiEiE iF# :< iEtFiF### it ##?F## ##### ti : <br /> REQUIREMENT INST MAX 1' " GENT <br />_ SAMPLE <br />TRLA?'1`1LNT F MEASUREMENT <br />1 0 O <br />0 PERMIT REPORI REPORT ?l #3t iF#it ###iE## ##3t it## _ FT7.TAT <br />, <br />I7J V REQUIREMENT 30DA AVC, DAILY MX <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT :... R -P' !?T -c_PL'R e ' <br /> REQUIREMENT 30DA AVM` Di'-:ILA' MX <br /> SAMPLE <br /> MEASUREMENT <br />!. 7 PERMIT RtPUKT '-.. =rx37 <br /> REQUIREMENT AST MAX r r <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />NAME/TlnE PRINCIPAL EXECUTIVE OFFICER I ee,Wy -der p...ty n Ia- 16.l thh dncvment and all stlechmenv were TELEPHONE <br />PRPared ander my direct{.. - tup" Wcn in atcordaner with a system designed DATE <br />to asYre IAN quatlrled persoarm properly gather and evaluate the Information <br />wrbmilted. based on my Inquiry of the per or Persona who massage the system, <br />J <br />1.• <br />- - or those penes directly re.7poldbk for tathMrrg the Information, the Information <br />1 aubmitled Is. to the best or my knowledge and belief <br />sccvrate. and c Pkte. <br />Irve <br />y <br />. <br />, <br />SIGNATURE OF PRINCIPAL EXECVTWE <br />l <br />dfk <br />t <br />b <br />llti <br />f <br />lse Inr <br />tk <br />' I <br />th <br />t th <br />ltk <br />f <br />TYPED OR PRINTED - am aware <br />a <br />ere are s <br />p <br />an <br />perna <br />s <br />or m <br />m <br />ng <br />a <br />orma <br />sn, <br />Inclu liol the poaalblilly of arse and Imprlsoanse rl for kno-Ing .ldauo"s. OFFICER OR AUTHORIZED AGENT CAE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Roforenc• sat attachments hersill <br />,,7 _F S01_? -' LIMIT APPLIED FOR =1OYR. <br />iI]NI T - I B. 2. <br />EPA Form 3320-1 (Rev 3199) Previous editions may be used. _ (; 115 i5 a.4-pan" form, PAGE OF