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PERMIT'TEE NAME)ADDRESS Rarbir Fwaty vm wLerrfan l(D(& w) <br />NAME <br />ADDRESS <br />J. J 0 x 187 <br />PAIG 816`6 <br />FACILITY • PPER MINE <br />LOCATION . )I G co 8162S <br />.,YMOND G. DU BOIS, PRES/QM <br />NATIONAL POLLUTANT OISCHMOE EUMINATION SYSTEM INPDESI <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 />OMti No. 20404004 <br />MINOR <br />( SIUBR <br />JC ) <br />F - F <br />POND INAL <br />#1 TO UTE GULCH <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FRECUENCY SAMPLE <br /> of <br /> EX ul?Y?s TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />I ! SAMPLE <br /> MEASUREMENT <br /> PERMIT ### REPORT . :NCE/ SUAI <br />_•i- ' ..:? ', REQUIREMENT I NST MAX MONTH <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT f <br /> REQUIREMENT ?J <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br />- - <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />_ <br />PERMIT <br />REQUIREMENT <br />NAME/TiTLE PRINCIPAL EXECIRTVE OFFICER T miy u er pent ly o Itw to et lhh doru ment and W attachments were <br />TELEPHONE <br />DATE <br />prepared under my direction or supenlslon In accordance with • system designed <br />. to annum that r uatir" personnel Properly tether and tealuale The information <br />I I t M, / ,. _" • 'l snbmitted. srwd on my Inquiry of the person or person who mange the eptem, <br />ar th <br />di <br />r <br />lbi <br />th <br />i <br />r <br />h <br />'t <br />? ?'? <br />• 'L <br />-- - <br />osr persorn <br />rw <br />y <br />espon <br />r <br />or ga <br />ering t <br />-. <br />om <br />e Inrornuuon, the Information ` <br />1/ <br />- <br />mbrniiled bi <br />b the best of my teas.ledge and belief <br />(raw <br />ac <br />urate <br />and c <br />kf <br />- - / <br />' <br />, <br />, <br />. <br />c <br />, <br />omP <br />e. <br />. <br />--? I am aware that thtm are lgNlicant Penalties for submitting faire Inforeaatlpt <br />SIGNATURE OF PRINCNAL EXECUTIVE . <br />- <br /> <br />TYPED OR PRINTED . <br />Inchrding the podbllly of not and Imprisonment for ?nowing .tdauorrL <br />OFFICER OR AUTHORIZED AGENT AREA <br />CODE NUIrWR <br />YEAR <br />MO <br />DAY <br />COMMENTS AND fAYLANA I IvN Ur Ain. vIVLA I Ions fffererenc• an srrecnrrlonrs narel <br />',I3LE SOLIDS LIMIT APPLIED FOR =I0YR,24HR PRECTP EVENT- <br />. <br />EPA Form 3320-1 (Rev 3199) Previous editions may be used. ) r)1 5E3 4'p?31 ?Or-M PAGE OF ??