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PERMITTEE NAME/ADDRESS (lweLiF.rMtryN?e rL«ufan yDlpirwr) <br />NAME <br />ADDRESS <br />J. BOX 535 <br />..3UNERSFT CO a <br />FAC0.ITY ^^INBORN CRK & ELK CRK MINES <br />LOCATION •IERSET CCJ 9 <br />••.nt?c 'r rnnacra cvcr^ to a <br />NATIONAL POLLUTANT DISCHARGE 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 />MINOR <br />(SUER MH) <br />F - FINAL <br />5FDIMFNT PI <br />Form Approved, <br />?)VH No 2040-0004 <br />I <br />NOTE: Read Inetructiorn before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. <br /> <br /> <br /> <br />X EQUENCY <br /> <br />OF <br />r <br />SAMPLE <br /> <br />TYPE <br /> 'Y <br />ANASIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br />`. PERMIT , . s ### t Y . b. 5 .. O 1NCF / 1H <br /> REQUIREMENT 3`I I t: i i il_'I'I MA X I t ,i.JM MONT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT NCE/ "7RAI3 <br /> REQUIREMENT e-IONTH <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT # #It#tE t< # >f? ### REPORT REPORT E/ 'R -0 <br /> REQUIREMENT 30DA AVG ?DAILY MX MONTP <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ###### IE##lt#II ###iE## 3500 7000 hJCI=/ ?Rf+113 <br /> REQUIREMENT 3t? )A AVO DA I L- Y MX MONTi- <br /> SAMPLE <br /> MEASUREMENT <br />1 0 ? PERMIT iF?;. ? ##IFititiE 1.p Off! Ih <br />` <br />.NT CRC REQUIREMENT INS! -ENT <br />IIN CON SAMPLE <br />i REAl ME MEASUREMENT <br />0 PERMIT REPOR ` REPORT #?t it#?# It II !F##iE #it## Itit =! I r:S ' H <br />RL7c ? REQUIREMENT ULA - a I L•Y MX ?T <br />L E.,lS'F SAMPLE <br />I „ MEASUREMENT <br />PERMIT #iE# # REPORT rr.#t? ? k#tt# It#; r.lCE SUAL <br />REQUIREMENT + NIST MA? <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I eema y under pens ty o law that this document and .II ¦ttarhmenb were TELEPHONE DATE <br />prepared under my dirertlon or wpet Won In accordance with a system designed <br />to aswre that quallfted personnel Property gather and evaluate the Information <br />wbmitted. Bred on my Inquiry of the Person or Persons who manare the system r I - <br />or those penere directly respons(bte for lathering the InformalkM the Informisdon t•i <br />•- <br />submitted K to the best of my knowledge and belW, true, accurate. and compWit. <br />rrneaM <br />w <br />that then am sl <br />enaltle for rbaitttn <br />Inf <br />SIGNATURE OF PRINCIPAL EXECVTNT <br />I <br />fak <br />ti - -. <br /> g <br />p <br />am s <br />an <br />g <br />e <br />orma <br />on. AREA <br />TYPED OR PRINTED Inetrsdlnt the possibloty of rim and Imprtsonment for knowing vlotauoas. OFFICER OR AUTHORIZED AGENT ODE NUMBER <br />C YEAR MO DAY <br />COMMENTS AND EXPLANATION yr knIT VIVLA I IW45 (rfererence on errecnmenrs nerel <br />r FRr! t- SC)l,IDS LMT APPLIED FOR. IOYR, 24HR PPFrTr, t?Fr.lr; <br />EPA Form 3320-1 (Rev 3199) Previous editions may be used. This 18 R 4-part form PAGE OF