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pERMrME NAME)ADDRESSQnr4r For4bq,N.u?Lx.den(/D -so) <br />NAME <br />ADDRESS = <br />EUX iD :,=s <br />?RSET CO 814 <br />FACILITY :3ORN CRK ?,, ELK CRK MINES <br />LOCATION IERSET CO 814 <br />1ES T_ COOPFR, FXFC V. P. <br />NATIONAL POLLUTANT OISCHAROE ELIMINATION SYSTEM /rNPDESI <br />DISCHARGE MONITORING REPORT (DMRI <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved. <br />OMB No 2040.0009 <br />MINI <br />F - FINAL GUN It <br />SURF RUNOFF TO N F7? t,,.;ra?S RIVR <br />>< <br />NOTE: Read kwtructforw before comp{etIng this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, <br />EX FREQofUENCY SAMPLE <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />_ SAMPLE <br /> MEASUREMENT <br /> PERMIT etc# IF at REPORT <br />##NF### <br />3t###? ;+ <br />i## f <br />- • .. <br />iN % <br />?' A <br /> REQUIREMENT IAST MAX .• hIONT <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 /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />IREMENT <br />E <br /> QU <br />R <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />I "Mil) under pease ty o law lhst thh docvnrM and ab attachments were <br />TELEPHONE <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER <br />DATE <br />prepared order my direrilon or eupervhlon In occordanre with • syatem designed <br />to assure that quatlflrd personnat property tether and evaluate the Information <br />• . ^?r?• ?1 wrb"lled. Bred on my Inquiry or the person oe penar who manate the syvten <br />, <br />_ _ <br />r <br />er <br />dir <br />lt <br />Mbi <br />f <br />th <br />I <br />ti <br />th <br />I <br />f <br />th <br />i <br />th <br />f <br />ti <br />or <br />ose p <br />sons <br />ac <br />y rnpo <br />e <br />or fa <br />er <br />ng <br />e <br />n <br />erma <br />m <br />e <br />n <br />orma <br />on <br />i . (submitted la, to the best of my knowledge and belief. Iroe. a mle, and compkte. <br />r. <br />?IONATURE OF PRINCNA EXECUTWIE <br /> 1 am aware that there are stgnifle"I penaltle for mbtrdldng robe informed". <br />TYPED OR PRINTED Incltding the poedbillty or fine and Imprisonment for knowing violatfoln OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIVLA I FVN5 (Haference M efracrlmenfs nerd <br />r' r v: FABLE SOLIDS LMT APPLIED FOR e=10YRr24NR PRECTP F'JFNT; <br />T T ., EVENT-SEE I A_ 1, PP 4- '. S. <br />EPA Form 3320 t (Rev. 3199) Previous ediLons may be used - J ??,??,,.. S.3 4- 371 form. AGE C5F