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pERMITTEE NAME/AOpRESSpweibiwWryN?w?Leerraw(/D(?w..r) <br />NAME <br />ADDRESS <br />J. BOX 535 <br />.'IERSET CO 81 <br />FACILfIY '(BORN CRK & ELK CRK MINES <br />LOCATION ;-IERSET CO 8i <br />,iMES T. COOPER, EXEC V. P. <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPOESI <br />DISCHARGE MONITORING REPORT /D RI <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO R. FROM TO <br />Form Approved. <br />OMB No. 2040-0004 , <br />MINUr- <br />( SURF m.p : <br />F - F I N AL <br />NOTE: Read kwtruetiorw before complet" thle form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION E <br /> <br />X <br />NO. <br />EX <br /> <br />FRED OF <br /> <br />SAMPLE <br />TYPE <br /> S <br />ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT #### # REPORT N ? ,t##### 3Ftt##it #####dF ?u, t:% V T7 <br />Ll1a.E <br /> REQUIREMENT INS T MAX t kz, ('IJNT <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/17TLE PRINCIPAL EXECUTNE OFFICER ' oert'ly -der penalty o I.- that thh document and all attachments -ere TELEPHONE <br />r.hl <br />n I <br />ith <br />i <br />d <br />d <br />i <br />i <br />l <br />d DATE <br />n accordance w <br />a sys <br />es <br />gned <br />prepare <br />un <br />er my d <br />rect <br />on or supe <br />o <br />em <br />/ to asvem that qualified personnef propMy Lather and evaluate the Information <br />ir <br />f th <br />? ! <br />d <br />S <br />d <br />I <br />h <br />h <br />- <br />y o <br />e person or persons w <br />i <br />• submitte <br />. <br />tee <br />on my <br />nqu <br />o manage t <br />e system, / <br />f <br />bi <br />I <br />- - <br />or thuae perm directly respond <br />e <br />or gathering the Infarmiatl, the <br />nfornuitbn <br />k <br />E <br />f <br />l <br />d <br />- <br />% <br />my <br />now <br />submitted b, to the beat o <br />e <br />ge an <br />beikf. 1r . at relr, and complete. <br />/SIGNATURE OF MIINCIFAL EXECUTIVE <br />i <br />l <br /> I am aware that there are s <br />gnificant pena <br />ties for rubmitting f,Lm infornattlen, RE <br />TYPED OR PRINTED InAuding the podbilily of fine and Imprisonment for knowing Aolnuorm I <br />OFFICER OR AUTHORIZED AGENT COOP NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Re%renc• eat •Kachments here! <br />Ti_.EABLE SOLIDS LMT APPLIED FOR '_: J Oti'R, ?ANT? PRFC T?' ? ;'F_mT, <br />-4HR EVENT-SEE i'P , <br />EPA Form 3320-1 (Rev. 1W) Previous earbons may be used. T Tlus is a,4-part form. 'PAGE OF <br />`? 1 .