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PERMITTEE NAMEIADDRESS(7-"Fedboy )Vataa/L ati-1/D(&-t) <br />NAME <br />ADDRESS <br />IiL 483 <br />;NIA CO 81428 <br />FACILITY : I E NO 2 MINE <br />LOCATION ?N I A CO 81428 <br />LL I AM A. BEAR JR. , MINE MGR <br />NATIONAL POLLUTANT DISCHAROE ELIMINATION SYSTEM (/NPOES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHAA43E 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 -- F I NAL DELTA <br />17SCHG OF SR TO GUNNISON RIVER <br />NOTE: Read k+stmeticne beltxe completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREOUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE ; <br /> MEASUREMENT <br /> PERMIT REPORT ,? st # #it# r:y II## IEit# IF#tt <br /> REQUIREMENT I NST W X <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 />E=LE PRINCIPAL EXECUTIVE OFFICER I Certrly under penalty ° law that thh docoment and all attachments went TELEPHONE <br />- DATE <br />prepared under my directlon or mper.lfon in accordance with • system, deeigrted <br />M <br />A <br />to ,arum that quaMned prn "o properly goth" and tcaluate the Inermmullon <br />sobmitted. Bawd on my Inquiry of the person a pertnen who manage the system, <br />or thaw perwm dlrectiy rtspunsibie ror gathering the information, the Inrormatlon <br />submitted h. to the best of my knowledge and beNer. true, secvnle. and complete. <br />IGNATURE OF PRINCIPAL EXECUTIVE <br /> 1 am ,wart Usal then an t rinlncant penalties for submitting faist Information, S AREA <br />TYPED OR PRINTED including the possibility of fine and Imprisonment for knowing rietatko OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference aN attachments hare) <br />?R 'RECIP F`.)Et+lT *c; 'L..AI?'fEn. Tr* CLATM APPROVED BY WnrCD, <br />NSUREME' <br />EPA Form 3320-1 (Rev. 3(99) Previous editions may be used ThiS• y-?ati ?A?t11- PAGE OF