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FERMnTEE NAME/ADDRESSt?mA-kF.eWjyN...?L afi-f/D(0eewr) <br />NAME <br />ADDRESS ?." <br />BOX 535 <br />"IERSET CO 81434 <br />FACILITY 13ORN CRK & ELK CRK MINES <br />LOCATION 1ERSET CO 81434 <br />.,MFR T rnnpFR, FYFC' V P <br />NATIONAL POLLUTANT OISCNARGE ELIMINATION sysTuA /rNPOESI <br />DISCHARGE MONITORING REPORT /DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR YEAR MO DAY <br />FROM MO DAY TO <br />Form Approved <br />OMB No. 2040-0003 <br />MINOR ` <br />(SUBR MH ) <br />- FINAL GUNI' <br />SURF RUNOFF TO Iii FK GUNIS RIVR <br />NOTE: Read kwtructlone before completing thb form- <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. <br />EX r SAMPLE <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT # tt # ## REPORT ##IE### #dr###a ? ## !{ <br />N ; <br /> <br />REQUIREMENT <br />INST MAX CifJT <br />) <br />! I <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 -m.fy " ndtr pena ly ° law that th <br />re <br />ared -der m <br />di-11on or su is dommem and .u attachments were <br />ervtflon In aaordanrt• with• s <br />stem darned TELEPHONE DATE <br /> p <br />p <br />y <br />p <br />y <br />th <br />t <br />lln <br />d <br />l <br />rt <br />d <br />l <br />t <br />th <br />ti <br />t <br />th <br />i <br />f <br /> pemonne <br />Prope <br />y e <br />er an <br />e <br />n <br />orma <br />on <br />o care <br />a <br />qua <br />e <br />eva <br />ua <br />e <br />submitted. Based on my inquiry of the person or per.om who mange the system. <br /> or these penens directly respenslble for fathering the Information, the Informatlon <br /> s"bmitted K to the best of my knowledge and bebef <br />true <br />a rsfe <br />and complete <br /> . <br />, <br />. <br />. <br />IONATURE OF MIINCNA( EXECUTIVE <br /> I am aware 1b.1there are signilncant penaltla for mbmifting false Inrormedon, HA <br />A <br />TYPED OR PRINTED lncluding 1M poadblury or nne.nd Imprnsoetmem nor knowing vid.Uord OFFICER OR AUTHORIZED AGENT DE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference aN effachmenfs here/ <br />r,.:;rl_F SOLIDS LI11T A''FL?TD FOR ? Cl`{f?: 24 fR P?tEC'P FV' itlT; <br />1'4T-SEE ? A ? . <br />fM@ ' .. 6.._ _ o _... PAGE OF <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used T}?? ?S 8,4-pan form