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PERMI'ME NAME)ADDRESS (I-&& F-r1NeyNawn?L«a,lon I/D(Qwwr) <br />NAME <br />ADDRESS <br />L'UX 4v;v <br />tiONIA CO 81428 <br />FACILITY - . r W I E NO. 2 MINE <br />LOCATION jNIA CO 81428 <br />LLIAM A. BEAR JR., MINE MGR <br />NATIONAL POLLUTANT OISCHAROE ELIMINATION SYSTEM NVOES) <br />DISCHARGE MONITORING REPORT (D R) <br />PERMIT NUMBER 04SCHAAGE NUMBER <br />MONITORING PERIOD <br />Y R MO DAY YEAR MO DAY <br />FROM I I d TO . I I <br />Form Approved <br />OMB No. 204040004 <br />MINOR <br />(SUBR MH) <br />F - FINAL DE! <br />WWTF TO DEER TRAIL DITCH <br />NOTE: Read linstrucdorw before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. <br />EX FRE U NCY SAMPLE <br /> ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT , <br /> PERMIT x>s ,- :. s4#it• ### ?' l CI NA ' -. <br />c^. REQUIREMENT 30DA AVG MX 7D AV i- ! <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT 30DA AVG i 1 7D iJNTH <br />- SAMPLE <br /> MEASUREMENT <br /> PERMIT < <br /> REQUIREMENT MINI MUM r`!A X I ft' I"I <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT _ <br />PUR UPI LU14AL ,. i • -. <br /> REQUIREMENT 301}A A?1G MX 7Cl AIV?, : i . <br />JNTH <br />MONTH <br /> SAMPLE <br /> MEASUREMENT <br />'CS 1 PERMIT <br /> REQUIREMENT 3 CnDA :'iV?; h(X 7 G A'.1 i'Qh1TH <br /> SAMPLE <br /> MEASUREMENT <br /> <br />:. - - PERMIT <br />?KO's REQUIREMENT ST MAX <br /> <br />11 v .. 11 1 r. SAMPLE <br /> MEASUREMENT <br /> - <br /> PERMIT LU7 <br /> REQUIREMENT 30DA I L.Y MX <br />PRINCIPAL EXECUTIVE OFFICER <br />M I mruty under pen' ty n isw that this dor.ment and .n ¦tiwhments were TELEPHONE DATE <br />NA <br />E/TITLE prepared under my dimclion or aupervWon in accordanea with a system designed <br /> to arose that qualified personnel property gather and evaluate the informatbn <br /> submitted. Bred on my tnqutry or the person or persons who manage the system, . <br /> or those persons dlrertly responslWe for gathering the Information, the Information <br /> submitted I& to the best of my knowitnip and beK , true. s-rate. and complete. <br />I am awan that there an dg IfIcanl pensltie for nrbmittin <br />War Inrornrtion <br />SIGNATURE OF PRINCIPAL EXECUTIVE - <br /> g <br />, <br /> <br /> <br />PRINTED <br />OR <br />TYPED <br /> <br />Inrchding the poaalblllty or flue and Imprisonment for knowing violations. <br /> <br />OFFICER OR AVTHORIZE0 AGENT <br /> <br />CODE NUMBER <br /> <br />YEAR <br />[ <br /> <br />MO <br /> <br />DAY <br />COMMENTS AND EXPLANATION or Ar4T VIVLA I TUNS fRSrsrsncs M srncnmsnrs nsrel <br />-7 INSTRUCTIONS - I. C. 10, PG. 10. <br />EPA Form 3320.1 (Rev. 3/99) Previous editions may be used. - Is & 4-part