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PERMITTEE NAME/ADDRESSpwrr6ra4kryN..?L.rton(/DIp4r.nrj <br />NAME <br />ADDRESS <br />BOX 483 <br />;C7N I A O 8142E <br />FACILITY •-•: I E NO. 2 MINE <br />LOCATION ..-.,NIA CO 8142E <br />- LLIAM A. BEAR JR., MINE MGR <br />NATIONAL POLLUTANT GtSCHARGE ELIMINATION SYSTEM (INPOESI <br />DISCHARGE MONITORING REPORT /DMRI <br />PERMIT NUMBER DISCHAAGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />MINOR <br />(SUOR <br />Form Approved <br />OMB No. 20404)004 <br />NOTE: Read Instructions beforig completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> OF <br /> EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT if IF#### REPORT J 's**I <br />- ., REQUIREMENT INST MAX <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 />NAMEfnnE PRINCIPAL EXECUTIVE OFFICER t merry under penalty o few that this document and all ettarhmenLs were. <br />TELEPHONE <br />DATE <br />prepared under m) directlon a fuperetlon In ertordance with • system dtlgned <br />to assure that guallfled personnel Is opeAy tether and evaluate the information <br />eabmtlted. Based ne my inquiry of the Pirrone or persons who menage the system, ' <br />tl <br />res <br />onsible f <br />o <br />th <br />dl <br />th <br />i <br />I <br />f t <br />th <br />' <br />p <br />ose persons <br />rsc <br />f <br />or ga <br />er <br />ng <br />r <br />e <br />n <br />lon. the Information - <br />submitted K to the best of m7 knowledge end belief <br />1r <br />ercnnte <br />and com <br />te <br />l <br />. <br />. <br />. <br />p <br />e <br />. <br />I am ..an that then are lpdflear penaloa for mbmltUng fatty Informetbm <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />- <br /> <br />-- <br /> . <br />I <br />f fl <br />h <br />t <br />ibilit <br />d I <br />f AAFA <br />TYPED OR PRINTED nr <br />+d <br />ee an <br />nt the poss <br />y o <br />mprisonment <br />or knowing Ooletlone. OFFICER OR AUTHORIZED AGENT <br /> <br />NUMBER <br />CODE <br />I <br /> <br />YEAR <br /> <br />MO <br /> <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS IReforenC1 0 s"schmenfs here) <br />n :I-f T''. r')FNT `73 CLATMFD TF' "L ATM APPROVEl, n'. <br />EPA Form 3320-1 (Rev 3/99) Previous editions may be used 11? 15,l 4-pj (-gr(I1 PAGE OF