Laserfiche WebLink
PERMMME NA ME/ADDRESS (7.A.& Fsr&,, N.WLecrraw if DO iaxi) <br />NAME <br />ADDRESS <br />BOX 463 <br />?:IA CO 8142E <br />FACILITY E NO 2 MINE <br />LOCATION JA A D 8142E <br />I TAIA a n;=PP .IG1 MT n11+ mr-NA <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM /rNPOES) <br />DISCHARGE MONITORING REPORT (OMR) <br />PERMIT NUMBER DISCHAROE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved <br />OMS No 2040-0004 <br />F -- FINAL DELTA <br />17 <br />7i? IB <br />SR. DEER .. <br />NOTE: Read Ifntnictlorw b-for* ComPltilt" tfib form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. <br /> <br />EX FREOUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALrss <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - ..X # c <br /> REQUIREMENT ;•?; j; ' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT DD A <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT _< } ;• ?,; ': tc #? - <br /> REQUIREMENT <br />,. SAMPLE <br /> MEASUREMENT <br /> PERMIT ?EPOR <br /> REQUIREMENT , TLY <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT i- <br />REQUIREMENT _ tKTf? <br />NAMElnTLE PRINCIPAL EXECUTNE OFFICER t re I,iy ° ndt' pens ly o ow that this document and alt stlschments were TELEPHONE DATE <br />prepared under my dlreellon a mper.lafm In scrordance with a eyetern designed <br />to amore that qualified personnel property gather and erahrale the Information <br />submined. assail on my Inquiry of the person or persons who rn.rr.ge the system. <br />ar those pence directly mpordb c for gathering the Informatlm the Information <br />submitted Is, to the best of my knowledge and belief, trot, scellnte, and compk/r. <br />dnc <br />I <br />m aware that the <br />l <br />l <br />n <br />lti <br />f <br />b <br />itti <br />f <br />I <br />f <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />I <br /> <br />TYPED OR PRINTED a <br />n an s <br />g <br />s <br />pe <br />a <br />or su <br />m <br />es <br />ng <br />¦ <br />se <br />n <br />ormation. <br />Including the posdblllly of line and Imprisonment for knowing rldauorea <br />OFFICER OR AUTHORIZED AOEffT A A <br />CODE NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reforence ale *rfachments hors) <br />EPA Form 3320-1 (Rev 3/99) Previous editions may be used This is a 4-part form, PAGE OF