Laserfiche WebLink
PERMITTEE NAMUADD LESS (Ines & F.,MyN..?L.r.H.e ((oo4 ,w) <br />NAME <br />ADDRESS <br />)NIA CO °142 <br />FACILITY ) I . NO. 2 MINE <br />LOCATION 11'4 IA CO 8142 <br />:LLIAM A. BEAR JR., MIME MGR <br />Form Approved <br />NATIONAL POLLUTANT OISCHARGE ELIMINATION SYSTEM IINPOES1 OMS No 2040-0004 <br />DISCHARGE MONITORING REPORT /DMRI <br />J, :11_}BR 11H <br />PERMIT NUMBER DISCHARGE NUMBER - FINAL -11=1 TA <br />A <br />s HE I)'?A I NAGE FL; SON R „: <br />MONITORING PERIOD <br />Y MO DAY Y R MO D <br />FROM TO <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. <br /> <br />EX FREQUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />'.r## 4-:r-.. <br /> MEASUREMENT <br /> PERMIT =<ci#st# tlst# _ 6. !3 ###### Cit. 0 _i' ra_•L <br /> REQUIREMENT MINIMt 'i MAXIMUM <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT r. ### # ## n # # F - . t r <br /> REQUIREMENT u4DA AV G Df; LY MX .;"?.H <br /> SAMPLE -' <br /> MEASUREMENT <br /> PERMIT 19 _3000 <br />b <br />r* - 1. <br /> REQUIREMENT '!ODA r' VG DAILY MX _ - MONTH <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT , l ••I ,. <br /> REQUIREMENT MAX <br />'1'.:. <br />:L(JT <br /> SAMPLE <br />Y<EAIMIL, •, MEASUREMENT <br />0 1 O O <br />PERMIT <br />`d'- OROE`_% REQUIREMENT 30DA AV"::• -?1L`i NX <br />` - - SAMPLE <br /> MEASUREMENT <br /> <br />C PERMIT <br /> REQUIREMENT i AST VV-0: <br /> <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />NAME/TrrLE PRINCIPAL EXECUTfVE OFFICER i nnrty under pen. t o taw that thIldocument and .It ¦Uechmenu wen TELEPHONE <br />di <br />li <br />ervisi <br />n I <br />ith a <br />i <br />d <br />d <br />d <br />d <br />d DATE <br />prepare <br />er my <br />m <br />on or sup <br />o <br />n accor <br />ance w <br />" m <br />gne <br />un <br />es <br />to assn that qualified personnel property gather and evaluate the Information <br />submitted. bred on my Inquiry of the person or persons who manage the system, <br />or those pcrsne directly responsible foe tathertng the Informalloa• the Infato Ue. <br />k <br />t <br />f <br />d <br />l <br />now <br />submitted Is• to the bes <br />o <br />my <br />ge and belief. Ime. a rate. and complete. <br />e <br />W <br />11 <br />t <br />lti <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />I <br />h <br />f <br />b <br />i <br />t <br />k <br />I <br />f .. <br /> 0 <br />c.n <br />am aware that t <br />ere are <br />pena <br />es <br />or a. <br />m <br />tUng <br />ee <br />n <br />ormation, <br />a AREA <br />TYPED OR PRINTED Including the possibility of fine and Imp6sonment for knowing riol.Uors. OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS /Roferonce DIM attachments hard <br />INSTRUCTIONS - I. C. 10, PG. 10 <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. 0049 1 / C•TIIUS 7S a 4-o87t fdrm. PAGE OF