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PERMITTEE NAME/ADDRESS17.n&&Frtbry Nams/Lo asionj/D(Qbwr) <br />NAME <br />ADDRESS <br />BUX 463 <br />CIA CO 9142E <br />FACILITY . ? E: NO. 2 MINE <br />LOCATION d IA CO 8142E <br />_LIAM A. BEAR JR., MINE MGR <br />NATIONAL POLLUTANT OISCHAROE EUMINATION SYSTEM //NPOESI <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved <br />OMB No 2040-0004 <br />MINOR <br />(SUBR MH <br />F - FINA <br />DSCHG OF <br />INNISON RIVER <br />ELTA <br />NOTE: Read kwtructlone before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREOUENCY SAMPLE <br /> OF <br /> EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT #,:. , . ;F## S #### 0 'EEKL't <br />. <br />1',F_ <br /> REQUIREMENT <br />n t. MINIMUM PAXINUM <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ri kite :. ,=its 35 ?O VLE1 :At3 <br /> REQUIREMENT <br />MON <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ####sE #a ar## xtl #it REPORT REPORT INCE/ ZRAB <br /> REQUIREMENT 300A AVG VAILY MX MONTH <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT #+lE##'! ;, #9F fFif ?f# ?: c :> ;0(r, )NC i <br /> REQUIREMENT 30DA AVG DAILY M7( <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT INST MAX : r <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT RED REPORT 'NSTAI' <br />L REQUIREMENT iC1Dr .;ILY MX <br /> SAMPLE <br />i ,1?` MEASUREMENT <br />- 7'. <br />PERMIT <br />r ^ >r <br />r s r. <br />REP {? <br />R <br />EPOR <br />C <br /> REQUIREMENT .rRTR R MAY, <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER t ttf11ty " `r pen' ty o (I.. that SAN docamrnt and alt attachments were TELEPHONE DATE <br /> prepared under my dinerthm or wise on In accordance with a system designed <br /> ta as"m that quahfkd Person" properly gather and esaluste the Information <br /> submitted. ¦aaed on my IngWry of me prn or persorts who manage the system. - <br />` <br /> or 'how persom dlreelly respendble for gathering the Information, the information -' <br /> submitted Is, to the bet of my knowledge and belle!, true. scc mir. and compkte. <br /> 1 am aware etas mere aresiFdfkant penaleks for submitting fate Information SIGNATURE OF ?RINCWAL EXECUTWE - - <br /> . ARE <br />TYPED OR PRINTED Including the possibility of fine sad imprisonment for knowing 0olatbm. OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANA I IUN yr ANT VIVLA I ivrgs !deference off saecnmonrs nerel <br />PREC IP EVENT IS CLAIMED IF CLAIM APPRnVED RY L•1!37i?, <br />;IJREMENTS-SEE I. A <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. PAGE OF