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PERMITTEE NAMEIADDRESSpwch-*FwoiyNm-dLe wi nl/D(f w) <br />NAME <br />ADDRESS l ?] <br />B L]? 5-.3 5 <br />1ERSET CO 81434 <br />FACILITY ;JBORN CRY, &. ELK CRK MINES <br />LOCATION r1ERSET CO 81434 <br />4AMFS T ( nnpFR. FXFC V P <br />NATIONAL POLLUTANT OISCHAAOE ELIMINATION SYSTEM //NPOES1 <br />DISCHARGE MONITORING REPORT (DMR) <br />FROM TO I I I d Form Approved. <br />PERMIT NUMBER DISCHARGE NIJMeEn <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />OMB No. 2040-000r <br />MINOR ` <br />(SUBR MH i <br />F - FINAL GUNI"t <br />gt.tR F RUNOFF <br />'0 TN FK_ GUN I S R I VR <br />NOTE: ReedInetiuctione before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. <br /> <br /> <br />EX FREOUENCV <br /> <br />OF <br />SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT #3E :; ?r### b 9.0 <br /> REQUIREMENT r:, {•: r? MAXIMUM <br />;; !•f <br />?T aL SAMPLE _- <br /> MEASUREMENT <br /> PERMIT x•u;t;r #e#It# i ?k?t#3 3? 70 {•,: <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ####jt it # # ### REPORT REPORT NCE/ ."RAP, <br /> REQUIREMENT X ONTH <br /> :=litA AVID DAILY M M <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ###### ##iF##dE 43 ## 1! # 35GQ TUOCJ i.f "/ <br /> REQUIREMENT ?GDA AVG DA IL`• NX l+si'dT <br /> SAMPLE <br /> MEASUREMENT <br />:' ? ! 0 PERMIT 10 ONT If'' <br />?rRG? REQUIREMENT INS1 MAX 'ENT <br />?Ih1 CONDUIT SAMPLE <br />1 MEN T P L MEASUREMENT <br />i O O PERMIT REPORT REPORT ###Ifxil #### ##### f-CKf If??:: =Ei <br />i_NT GROSS REQUIREMENT :30I?A A(Jr;, !'AILY M: -rrtiTF <br />.„ TOT A[. SAMPLE <br /> MEASUREMENT <br />PERMIT K?Ej:'::#### REPORT REPORT <br />REQUIREMENT O1A AVGJ DAILY IaX <br />NAME/TfTLE PRINCIPAL EXECUTIVE OFFICER i nrtrty under pens iy ° law Choi thh dommtnt and all sttarhmenU were TELEPHONE DATE <br />prepared "nder my dim0on or mper.Mon In smordance with • system deigned <br />to care that qualified personnel properly gather and tsahr Ott the Infonrutlon <br />sabrdited. Based on my Inquiry of the pen or Person who manor (M "t <br />f <br />i <br />i <br />l <br />i or than ptrsore directly respons <br />or gathering the <br />b <br />e <br />nformation, the information <br />?. - submitted la, to the bet of my knowledge and belief. true, sceumfe, and complete. L- - - - .- <br />/ 'S '- l ? I <br />i <br />ifi <br />nt <br />id <br />SIGNATURE OF PRINCIPAL EXE6UTIVE <br />th <br />t th <br />f <br />t <br />1 - <br />, <br /> am aware <br />gn <br />a <br />en are s <br />ca <br />pres <br />es <br />or submit <br />ing raise Intormation. AREA <br /> <br />TYPED Oft PRINTED Intiudi the bill[ or Ilm and tm rfsonment roe lim-Fri efotauorm <br />cat P°d y p g OFFICER OR AUTHORIZED AGENT NUMBER <br />CODE YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference eh ettechments here) <br />{t; (71'1( Ina <br />- M ;"Pi TED FOR _= IOYR, 24HR P:,-: 71?- - - <br />LJr L f - C i'.! V I t c'r F. <br /> <br />_ <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. This ill a 4-part Form. <br />; 1 ?" PAGE OF