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PERMITTEE NAME/ADDRESS p..6& F.4hy N..?L ollr I/D(Qwwe) <br />NAME <br />ADDRESS <br />bUX 187 <br />E -AIG CO 81 <br />FACILITY '-APPER MINE <br />LOCATION I G co 81 <br />aYMOND G. DU BOIS, PRES/01v <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDESI <br />DISCHARGE MONITORING REPORT /D RI <br />PERMIT NUMBER DISCHMOE NUMBER <br />MONITORING PERIOD <br />Y R MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved <br />OMB No 2040-0004 <br />MINOR <br />(SUBR JC) <br />F - FINAL <br />DISCHARGE TO COYOTE GULCH <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO• <br /> <br />E FREQUENCY <br />OF SAMPLE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS X ANALYSIS TYPE <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT 5 L) ; _ , <br /> REQUIREMENT MINIMUM-1 - ?- MA-%j MUM <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT a: F <br /> REQUIREMENT DAIL MX MOO T H <br /> SAMPLE I <br /> MEASUREMENT J <br /> PERMIT <br />` <br /> REQUIREMENT ?? i .SODA AVG Y MX MONTH <br /> SAMPLE <br /> MEASUREMENT <br />_ s <br />l PERMIT , ..., <br /> REQUIREMENT QF A V G DAILY MX MONTH <br />T SAMPLE <br /> MEASUREMENT <br /> <br />-i2 1 ii <br /> <br />.-.N i ERG PERMIT <br /> <br />REQUIREMENT <br />7- 7 -K \ <br /> <br />I NSI MAY. <br />1' <br />.:. SAMPLE <br />REA[ML- i+ I'! MEASUREMENT <br /> <br />1 0 0 PERMIT RE-1,014 I - . <br />GROSS `., .- REQUIREMENT )ILY MX <br /> SAMPLE <br /> MEASUREMENT <br /> <br />PERMIT <br />REQUIREMENT A A' 1 LY MX <br />I <br />NAMEITITLE PRINCIPAL EXECUTIVE OFFICER pnrepTaoremd Yndunder tr my peso di oreetlon i•w w that <br />w+pthis tr p.. t 1 o on In n accorenddseursce en with s tnenef fystewm en designed TELEPHONE <br />rfl <br />- to oars that quallfW personnel property gather and evaluate the Information <br />^/ ,'Y; ?! • "? / submitted. booed on my Inquiry *(the penom or peens who mange the system. <br />/ - or those pence dimity responsible for Ielherin j the Informetlew, the Information J " - / - <br />.sbntllted h• to the best of my knowledge and beat!, Irve, arsvnte, and trampled. l <br />?? C +"' ?''" •' i? I am swan that there ¦n significant prnslths for submilug hie Infornstkm <br />SIGNATURE OF FRINCNAL EXECUTIVE <br /> <br /> <br />ATE <br /> <br /> <br /> <br />" <br />TYPED Oft PRINTED . <br />Indudlnt the Possibility of Raw and Imprisonment fa knmwig .iolsuarts, OFFICER OR AUTHORIZED AGENT A A CODENUMBER YEAR MO DAY <br />COMMENTS AND EXPLANAIIVN VP- EMI T VIVLAtIVNS Ixerorence on •rracnmsnrSnerel <br />ABLE SOLIDS LIMIT APPLIED FOR <.=10YR,24H <br />DS MONITORING - I . B . 2. <br />IREC IP EVENT- <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. O C1 1 I S