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PEAWME NAME./ADDRESS(7.,&* Forfhry Afeaa/L-.n-((Dj&ws) <br />NAME <br />ADDRESS <br />BOX 187 <br />=G CO 811 <br />FACILITY !--P F R MINE <br />LOCATION -0 <br />CO all <br />MOND G. DU BOIS, PP.ES/GM <br />NATIONAL POLLUTANT OISCHAROE ELIMINATION SYSTEM //NPOES) <br />DISCHARGE MONITORING REPORT (DMR) <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 />MINOR <br />( SUBR JC ) <br />F - FINAL MOFAI <br />DISCHARGE TO H09SE GULCH <br />NOTE: Road Instructions b.hro completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. <br /> <br />EX FREQUENCY <br />OF SAMPLE <br /> <br />YPE <br /> ANALYSIS T <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT REPORT =-.. # Ye; ###it # iP### 3 CE / r1 <br />?LU;`a i .': .. REQUIREMENT IN57 MAX fl,-,- MONTH <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 /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER t Ce^'/r " a°a ly ° law that NN doroment and all attarhenents were TELEPHONE DATE <br />prepared under my direction or superHsfon In s rdame with • system designed <br />/ - to assure that quaMM1ed person M Property laths and evaluate the information <br />` <br />- <br />- - snbmilled. Saud on my Inquiry of the Prstm or <br />/. <br />• <br />_ persona; who manage the system, - t1 <br />or those persme dimity responsible for galherlnt the Information, the Information <br />submitted b, to the best or my Lno.Ydile and belief. Irue, arettnte, and romphte. : • 1 - =. / <br />610NATURf <br />Of PRINCIPAL EXECIJTrVE <br />w <br />re th <br />e a- sl <br />.M-l <br />rnaitles for suhlttln <br />hM Inro <br />/ <br />' 1 <br />t th <br />etl <br />?• .:i <br />- it <br />p <br />am a <br />a <br />er <br />t <br />r <br />on. <br />a . ARE <br />TYPED PRINTED Iartding the poaaiblllly of fine and Imprisonment for knowing .td.U- OFFICER OR AIJTHORiZED A.OENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION Vr ANT VIVLA I IONS (rf#r*r#nC# sat errscnm*nra n#r@j <br />ABLE SOLIDS LIMIT APPLIED FOR -'=10YR,24HR PRECIP EVENT- <br />7 DE' DS MONITORING - I . B . 2. <br />EPA Form 3320.1 (Rev, 3/99) Previous editions may be used . Tips is a- 4-p prm.