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FERMITTEE NAME/ADDRESS(-&&F tWty N&../Lac.tto.I/D(fb t) <br />NAME <br />ADDRESS <br />35, LiJA J7U <br />_LPER UT B4?26 <br />FACILITY ' `dGER C ;N ;'ON MINE <br />LOCATION 1A CO <br />-taBID B. MILLER, BUSINESS MGM <br />NATIONAL POLLUTANT OISCHAAOE ELIMINATION SYSTEM IrNPDESI <br />DISCHARGE MONITORING REPORT tDMRI <br />PERMIT NUMBER DISCHARGE NUMSM <br />MONITORING PERIOD <br />FROM YEAR O DAY TO YEAR MO DAY <br />Form Approved. <br />OMB No. 2040.0004 <br />( SUDF1 rl:; <br />F - FINAL GNFL <br />5ED POND DSCHG TO MUNGER CREEK <br />NOTE: Read {natructiorw befwo complet" this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FRI F cv <br />of SAMPLE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSrs TYPE <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br />_UENT 6i-: REQUIREMENT M'\'". ... =1; <br />_ SAMPLE <br />JF'ENDF;; MEASUREMENT <br />n <br /> PERMIT <br /> REQUIREMENT <br />= SAMPLE <br /> MEASUREMENT <br /> <br /> <br />u `. PERMIT <br />REQUIREMENT <br />' <br />- SAMPLE <br />!%S FF : MEASUREMENT <br /> <br />- PERMIT <br />REQUIREMENT ..,. <br />t_Y Fix <br />'; i.' 017 SAMPLE <br /> MEASUREMENT <br /> <br />U2 1 <br />__UEiVT op. PERMIT <br />REQUIREMENT <br />INfil ;'it <br /> SAMPLE <br />'J TREAT:-t__: MEASUREMENT <br /> <br />;O 1 PERMIT <br />'._UENT GROG' _ REQUIREMENT 'A AVG DAILY MX <br />AN5 - SAMPLE <br />%AL MEASUREMENT <br />1 <br />r <br />PERMIT <br />REQUIREMENT t'JS I ? ^'; ; <br />NAME/T1TLE PRINCIPAL EXECUTfVE OFFICER I mrtrty ° er pore ty o law that thh document and ¦ll flachments wrre TELEPHONE <br />prepared under my dlrertlon or superetslon In arcordanre with • system designed DATE <br />1 to inure that quallned personnA property gather and evaluate the information / <br />fuEmltled. Based on my Inquiry of the person or prmcma who manstr the ,rrtem, `4 <br />or those persom directly mpornlble for gathering the Information, the Information 11 <br />LCn; %. - 7 <br />\ submitted Is. to the best of my knowledge and better. Irv., amurste. and complete. -'- 1 <br />y <br />?" ? I am aw.re that there are rlgNM1cant penaltles for wrbmrwng ra6e Information <br />ifONATUAE OF PRINCIPAL EXECUTIVE <br /> <br /> <br />/ <br /> <br />J <br /> <br />TYPED OR PRINTED . <br />Including the possibility of f1w and Imprisonment for knowing v olnUorn. <br />OFFICER OR AUTHORIZED AGENT AREAJ <br />CODE NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS IReforence eN attachments hare/ <br />LEABL F SOl T DS I MT APPLIED FOP 1 t?YR . 24HR PREC I P <br />_ pp 117 <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. This i5 'a 4-part fdryn. PAGE OF