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PEA 41TTEE NAME/ADDRESS (Jnd.?. i.rtEtry New.rterrton t/D(DL..wr) <br />NAME <br />ADDRESS <br />BOX 483 <br />WIA C0 8 1 42e <br />FACILITY IE NO 2 MINE <br />LOCATION NI A CO 81 428 <br />I T A. A a Q=AD 1p MTN= MCP <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM /INPOES) <br />DISCHARGE MONITORING REPORT (DAIR) <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 />MINOR <br />(SUBR MH ) <br />F - FINAL DELTA <br />SR i DEER TRL DTC OR UNMD 1-R I B <br />NOTE: Read If»tructlone before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, fREOUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE :.... T <br /> MEASUREMENT <br /> PERMIT I IEEKLY NSI T <br />IL' <br />REQUIREMENT <br />Iff I t•, ; ,.. <br />:1A X I MUM <br /> SAMPLE <br />MEASUREMENT <br />C: PERMIT s #+f st# at x ## ? > ..; - s= <br />CE/ <br />TIR-AFF <br />-NT GROSS V/ REQUIREMENT MONTH <br />SET.TI_ T- SAMPLE <br /> MEASUREMENT <br />- t {} PERMIT ?i-fr#-'f-!i•# ##•###•'E ?• ?###•?? REPORT R5FORT I- ? <br />-? "Ross REQUIREMENT 3 0 D A =; DAILY MX :'• MONTH <br />i i T AL SAMPLE <br /> MEASUREMENT <br /> PERMIT ##?E 3f ?# 1s###aF? r ;f#at {s it v 30001 6000 NCE/ 'TRF?B <br />IJFt REQUIREMENT 30DA AVk DAILY !IX MONTH <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> <br />J PERMIT <br />T <br />ON IN <br />w, r CIS ti: REQUIREMENT -- INST MAX <br />ONr <br />SAMPLE <br />MEN -; '7-! MEASUREMENT <br />O 1 Q D PERMIT REFQR 7E P RT #z-.tt .:c <br />I. tJEN f GROSS V., I REQUIREMENT LY Mr <br />lr'.j[1 t-' ?3 F SAMPLE ,- <br /> MEASUREMENT <br /> <br />PERMIT l # ??» # t * :r ## -JAL <br />REQUIREMENT ;-r <br />NAME/TITLE PRINCIPAL EXECUTTVE OFFICER t frilly " er Pen• ty law that thh document .nd A eltochmnots were TELEPHONE <br />pmPand under my dimil.n or mpenlslon to wcord.m with • system desltnd DATE <br />to ae " that qualified personnel Pro9edy Lather and tyaluate the Infmmallon - <br />l <br />rJ of the Perron or pampa who manste the ryst,m. _ <br />eubmltted. Eased on my Inqu <br />or those persom directly respordble for plhertrtt the wormao n. the Information <br />- mbroitted Is, to the best of my knowledte and beW, Ime. tlrellmle. and complete. <br />IGNATURE OF PRINCIPAL EXECUTIVE <br />• I a. swsry that there on eltNtleast penalties for subm11tinE rater Information, S AREA <br />TYPED OR PRINTED InAudint the po sibuny of floe and impr4sonment for knowlnt .lol.uwn OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Rsforence &M attachments hors/ <br />r- T. r_..,rrlr Tr ? r.MFD Tr ('!.:^. T M APPRrl17T'• r3Y WC1rC), <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used This IS a 4-parr form PAGE OF