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PERMITTEE NAME ADDRESSQweis4Fecory N.+?Location ?pGrn,l <br />NAME <br />ADORESS <br />BOX 187 <br />'. G CO 8162E <br />FACILITY ?PER MINE <br />LOCATION , G CO 816 2 EE <br />sMOND G. DU BOIS, PRES/GM <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (/NPOES/ <br />DISCHARGE MONITORING REPORT IDMR) <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 />( SUBP. JC ) <br />1= - FINAL <br />POND #10 TO JOHNSON GUI. <br />NOTE: Read k»tructlorn before cornpleting 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 /> SAMPL E <br /> MEASUREMENT <br /> PERMIT ### REPORT ###; #!F### It# ## INCE/ VISUAL <br /> REQUIREMENT 1 NST MAX r.if,:- _ MONT <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 /> 11 PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />NAMEfnnE PRINCIPAL EXECUTNE OFFICER 1 Z;M15 " er pens ty . I.+ th.t the docvnwnt and u ¦Ilachmenu were <br />* TELEPHONE <br />prspared order my dlrectbn or super.Hon In accordance with. system designed <br />DATE <br />to assure that q-11ned personnel property gather and evaluate the Informatlon <br />submitted. Bawd on my Inquiry o(the person or persons who mange the system, r <br />presets directly responsible for gathering <br />or thaw IM InfernuUnn, the information <br />t <br />submitted Is, to the bes <br />or my tnowkdIt and belief. true. accurale, and complete. <br />nificant <br />I am aware that there are si <br />ertaNte for wrbmlltln <br />false Inform <br />iIONATVRE OF MINGIPAL EXECIlT1VE <br />tion <br /> g <br />p <br />g <br />a <br />, <br />a <br />TYPED OR PRINTED Inchding the possibility or fine and Imp <br />m moot for Rnowing viol.tlons OFFICER OR AUTHORIZED AGENT CODE N <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS fR•F.r•nc• N/affacnmanta haral <br />APL-F SOLIDS LIMIT APP!_IF_D FOR --_=10YP, 24HR PRFcIP EVENT- <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. U ? 36 ! C j5)W4-pWir F0rr11. PAGE t)F 1 <br />C^?