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FERMITTEE NAME/ADDRESS hairs" FeemeyNaaa?leeanaw (/D(dbrw) <br />NAME <br />ADDRESS J I r <br />L,IJA JJJ <br />-RSET CO <br />FACILITY :TORN CRK & ELK CRK MINE <br />LOCATION ._RSET CO <br />IES T. COOPER, EXEC V. P <br />NATIONAL POLLUTANT DISCHAROE ELIMINATION SYSTEM NPOESI <br />DISCHARGE MONITORING REPORT IDMRI <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved. . <br />OMB No 2040.0004 <br />M I P40R <br />(SUOR MH ) <br />F - FINAL <br />SEDIMENT POND TO HUBBARD CF <br />NOTE: Read Instfuctiom before 'completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, ENCY <br />FR <br />COV SAMPLE <br /> f <br />o <br /> EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT ti ## x # 6 <br />5 #3F## - :? `7 <br />G l? rT- =4 1 T' <br /> REQUIREMENT . <br />MINIMUM . <br />MA X 11` MUil MONTH <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT :Ew?k### ,r s?### _.? NCL.i <br /> REQUIREMENT i7T <br />` SAMPLE <br /> MEASUREMENT <br /> PERMIT :! ##if DE 9F 3tiF#### REPORT REPORT? _ r A <br /> REQUIREMENT 30DA DAILY MX MONTH <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT it3 ## #### )f# ###### 3500 70(';C) <br /> REQUIREMENT :3CIDA r`•VG DA I L V i`i:S <br />..r <br />!'•i T F <br />- SAMPLE t <br /> MEASUREMENT <br />`32 1 v PERMIT iFit i1 3FiF ?i 3F#iF IEiF 4..-, x ; ## ###3F it?F 10 <br />i r• <br />IJENT EROS.`- '. REQUIREMENT ,,- <br />-4, N NDUI i SAMPLE :-, - F <br />J TREATMENT (-; MEASUREMENT <br /> PERMIT RE lJRT REPORT <br />## ## <br />,: i <br />j,;t <br />t <br /> <br />A i' <br /> REQUIREMENT LODA AV-: ' IAILY MX <br />PGr•1Ti- <br />HNL% r.. SAMPLE <br /> MEASUREMENT <br /> <br /> <br />REQUIREMENT I NS T MAX. "rC?NT. <br />NAME/TiTIE PRINCIPAL EXECUTIVE OFFICER 1 nrtrlr under Penalty a is. that Is document and all allachments ..ere <br />TELEPHONE <br />DATE <br />prepared under my dlryr Non w superrhlon In accordann .ItA • system designed <br />-•? <br />\ I. <br />Yf ?? ! Io inure thN qualified personnel properly gather and eyduate the Infnrynallon <br />b <br />itt <br />I <br />d <br />B <br />d <br />i <br />- - - <br />. su <br />m <br />e <br />. <br />ase <br />nqu <br />on my <br />ry of the person w person who nonage the system, / <br />' <br />1 <br />? • -.. <br />--- or than perm directly rrapomlble for gathering the Information, the Inrornstlon _ <br />/ <br />(r! . - <br />` ? <br />? submitted b, to the best of my knowledge and beW. true, amrmle. and complete. _- <br />. 1 am ewer: that there are significant Penaltles far rubmltting rate Information, &IONATURE OF PRINCWAL EXECUTT/E <br />TYPED OR PRINTED Including the poa?bllltf of Ilm and Imprisonment rw knowing rtolatlors< OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPL.ANAI IvN OF ANY ViOLA INNS (Reference s// sttechments here! <br />i• 1 _I TLFABL E 9nl_ TO APPLT.Ft?-n1T -- ;r-YR, 7/1 FiR PFd`:""TT, 1- <br />,_ r, <br /> r <br />t. 50 <br />EPA Form 332G-1 (Rev. 3/99) Previous editions may be used. ? <br />This is. 3.4-pall jprTfly <br />_ r. ..: <br />PAGE" <br />OF <br />i