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PERMITTEE NAME/ADDRESS(Ineir&F-bbYNo-WL«riam(/DUbrwi) <br />NAME <br />ADDRESS <br />13UX n:JS <br />.=RSET CO 81434 <br />FACILITY 31ORN CRK & ELK CRK MINES <br />LOCATION J RSET CO 81434 <br />'. -!;= CZ T f nnPi P. FY;:r k; P <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION T/STUA fNPOESI <br />DISCHARGE MONITORING REPORT /O R) <br />PERMIT NUMBER DISCHARGE Nl1MeER <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 Ii <br />F - FIt ; - t?tJT <br />gt )R F RUNnFF TO N. FK GUN I S R I V <br />NOTE: Rood Instructions before complsting 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 /> MEASUREMENT <br />1 PERMIT S## REPORT <br />le <br />- <br />WT REQUIREMENT INST MAX MONTH <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 /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER t Cemay under penalty o I.w that this cl c rncnt and Wl aflorhments wane TELEPHONE <br />H <br />b <br />I <br />ith <br />t <br />i <br />d <br />d <br />d <br />i <br />l <br />d <br />d DATE <br />un <br />on or super <br />S <br />n <br />n a r <br />.nce w <br />a sys <br />em <br />es <br />gne <br />prepare <br />er my d <br />reci <br />l <br />r <br />- <br />lkd persem ni Property gather and evaluate the In <br />nrmatlon <br />yy to assure that quel <br />of the <br />erson or person who mana <br />submitted <br />bred on m <br />in <br />e the s <br />stem <br />uir <br />. <br />y <br />p <br />g <br />. <br />q <br />y <br />y <br />a those person directly responsible for gathering the Information, live Information <br />f <br />k <br />r, <br />my knu. <br />dge and beW. true, accvnle, and a plele. <br />r Y-- submitted Is, to the best o <br />IGNATURE OF PRINCIPAL EXECUTIVE <br />` . <br />y I am swan that there New dgdfkaM penalties for submitting nine Inrormation, AREA <br /> Including live powib lity of Ilse and Imeprisonevent for knowing etoleuons OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />TYPED OR PRINTED . <br />COMMENTS AND EXPLANATION OF ANT VIVL.A I tvrvD I/TSrsroncs an atiecnmmta ntrrai <br />1. FABLE SOLIDS L MT APPLIES FOR e'=10YR, 24HR PREC I P EVENT, <br /> I. A. 1, PP 4--`: S. <br />t *' I lE P. Al a ?h T HTaHFS7 Mt TD <br /> - This IS a 4-pail f4r111. <br />CIO-) j PAGE OF <br />EPA Form 3320-1 (Rev. 3/49) Previous editions may be used .