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PERMITTEE NAME/ADDRESS J7-"FecOryiV..WL-or,on (f D(, ,-f) <br />NAME <br />ADDRESS <br />JIA CO 8142 <br />FACILITY NO. 2 MINE <br />LOCATION J IA CO 8142 <br />_LIAM A. BEAR JR., MINE MGR <br />NATIONAL POLLUTANT DISCHARGE EUMINATION SYSTEM fNPDESI <br />DISCHARGE MONITORING REPORT IDMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />O D Y <br />Y JAR MO DAY I Y AR 1 !4 <br />FROM TO - <br />Form Approved <br />OMB No. 2040-0004 <br />MIN_1R <br />(SUER f1H ) <br />F -- FINAL DE <br />WWTF TO DEER TRAIL DITCH <br />NOTE: Read k+etructlon i before completing thle form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. <br />ENCY <br />FREQUOF <br /> <br />SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br />C PERMIT . c <br />5. VAL!.:: REQUIREMENT 30DA AVG DAILY M{ <br /> <br />fit SAMPLE <br /> MEASUREMENT <br /> PERMIT 11W W"IfIrwW <br />? <br />? <br />r.. <br /> REQUIREMENT I PJST I'I/; •t <br /> SAMPLE <br /> MEASUREMENT <br />5 PERMIT a _, <br /> REQUIREMENT 10DA AVIV I1X7DGEOA MONTH <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />a REQUIREMENT ' NST MA k <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER 1 carol, "der pen' y ° how Choi thh domment end all attachm <br />ervym In 1-rda with <br />ared under m <br />dirertlm a su <br />re ents wort <br />• s <br />stem designed TELEPHONE DATE <br /> y <br />P <br />y <br />P <br />p <br />to -m that qu&Kned perw awl Properly gather and evaluate the Information <br />wbrritled- Based m my Inquiry of the Person or persore who manage the system, <br />., <br /> w Chow persas direrty responsible for gathering the Inftirmatlon, the information - - - <br />- to the best of my kwawkdge and bebef <br />Iroe <br />accurate <br />and rnmpkte <br />submitted b - - <br />-? + <br />-' <br /> , <br />. <br />, <br />. <br />. SIGNATURE OF PRINCWAL EXECVTIVE ) <br /> 1 am aware that there are signlfIc"I penalties for submitting rate Infomrotd", A A <br />TYPED OR PRINTED Inrluding the Possibility or floe and Imprtionmeni for knowing Aclodom OFFICER OR AUTHORIZED AGENT CAE NUMEIER YEAR MO DAY <br />COMMENTS AND EXPLANA I IUN yr nn r viwLm a tvrtia <br />renew w, ----w-- --i <br />NSTRUCTIONS - I. C. 10, PG. 10 <br />EPA Form 3320-1 (Rev- 3/99) Previous editions may be used This IS a 4-part