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PERMITTEE NAME/ADDRESS pna" FacOry Af..WLac«iow t/p(0be.r) <br />NAME <br />ADDRESS p , : F !•'•, f 1% <br />J. BOx J,JJ <br />`: `JMER SET CO 61434 <br />FACILITY I :,NBORN CRK & ELK CRK MINES <br />LOCATION - IERSET CO 81434 <br />aMFR T C'IVIPFR. PY1=f t) P <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM /NVPDESI <br />DISCHARGE MONITORING REPORT IDMRI <br />PERMIT NUMBER DISCHMIGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MY <br />O <br />FROM TO <br />Form Approved. <br />OMB No 2040-0004 <br />MINOR <br />(SUBR MN ) <br />F - FINAL <br />SEDIMENT POND TO SANBORN CR1 <br />i? <br />NOTE: Read Instructions before completing We form. <br />T <br />'.JN i S <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREOUENCY SAMPLE <br /> OF <br /> EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE = ; t : <br />I x <br /> MEASUREMENT <br /> PERMIT #### ;+;,##•p••?: A:, & ###.?" Q NCI <br /> REQUIREMENT <br />LS, 17OTAL. SAMPLE <br />P EPJDG --, MEASUREMENT <br />_ PERMIT ?G Tt AE <br /> REQUIREMENT <br />?1rf•?T• <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT #!s### #### ? '? #### REPOR. ` REPORT ?NCEf j,-, rAr <br />. REQUIREMENT '+j?)r"?1 ?'•` - DAILY M11. "O NT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT #####? ###### ####3># 3S0 0 7000 _lNCE/ BRA:' <br /> REQUIREMENT 30DA AVG. DAILY MX Yi0NTt <br />1) 1- . , SAMPLE <br /> MEASUREMENT <br />O Q PERMIT 1.0 "ON , F , •:3 <br />t <br />: REQUIREMENT <br />•, <br />:;ROSS 1AX <br />ONDU 1 SAMPLE <br />i MEifT L' MEASUREMENT <br />?_••_, i <br />0 Q PERMIT REPORT REPORT ?'?# - #?t# x #>t ;;lt?F/ IFiO <br />L-UENT GROSS REQUIREMENT 30DA A'•,%`= 'DAILY MX JATF <br />ANE) izREASE SAMPLE if# <br />L MEASUREMENT <br /> PERMIT REPORT # ## a * ## ?r# :: 3N CE/ .f I SU <br /> REQUIREMENT INST MAX MON;T <br /> <br />NAMEfnTLE PRINCIPAL EXECUTIVE OFFICER 1 Mrl, f and" penalty or law that UM document and all attachments weR <br />TELEPHONE <br />DATE <br /> p,pamd under m direvilon or w <br />y per Hlon In accordance' with . flflem designed <br /> <br />. to asure that qualified personnel properly father and eealnale the Information <br />submitted. Bred on my Inquiry or the pvsuo w Persons who manage the system. <br /> or those persons directly respaldble for gathering the Information, the Informaton t 1 , :,: J I <br />I / I r fi / _ / -7 <br />/ / r + <br />- <br />? wbmilted K to the best of my knowledge and belief, irw, arrumle• and complete. <br />I am await that there are signifl-nl penalties for submitting fatse lnfo tlon <br />SIONATURE OF PRINCIPAL EXECUTIVE _ J r <br /> . <br />I <br />di <br />l <br />fl <br />TYPED OR PRINTED nc <br />u <br />ng the poadblHty of <br />ue and imp fsonment for knowing Holad rei. OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMEN 15 ANU tAYLAPIA I Ivls yr nn r s Ivt.n I Ivn-? Ir*srvrsncw an <br />arracnmanra nsrsr <br />D;: - FAnL_F rnI- T DS LMT APRL I FD FOR C =10YP, 24HP PRFr' n r T <br />t -•. i <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used prM. PAGE OF