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FERMITTEE NAMUADDR,ESS (Jmelwlr f.rWry N..?Lse.iia I/DoWvwm) <br />NAME <br />ADDRESS <br />BOx 187 <br />",I G CIO 816 <br />FACILITY !"PER MINE <br />LOCAnON ? i G co 916 <br />NATIONAL POLLUTANT DISCHARGE EUMINATION SYSTETA //NPDESI <br />DISCHARGE MONITORING REPORT IDMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YE R MO DAY <br />FROM TO <br />Form Approved. <br />OMB No 2040-0004 <br />MINOR <br />(SUBR JC) <br />F - FINAL <br />DISCHARGE TO HORSE GULCH <br />NOTE: Read kratrucdone before Jcompleting thh fam. <br />RAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO FREQUENCY <br />of SAMPLE <br />PA EX YSIS <br />A TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS AN <br />L <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> <br /> REQUIREMENT T!-,1ST MAX <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT 1 <br /> REQUIREMENT i <br /> SAMPLE <br /> MEASUREMENT j <br /> <br /> PERMIT r <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br />PERMIT <br />REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER t fe`l'l' ° penalty o low that this document and au attachments were TELEPHONE <br />prepared under my direction or superwhlon In acordann with • system designed + DATE <br />- 10 mere that qualified personnel properly lislher and evaluate the InIbesnation <br />?- _.. submitted. Bred tm my inquiry of the person a penoes who manor the system <br />or those persom directly responsible for gathering the IntornuUen, the information <br />submitted Is. to the best of my knewledEe and beW. true, accurate, and complete. <br />T <br />E <br />? <br />?-r^ `t j1 '- -% <br />r + I am swan that (here art s1gdM1cawt wnaMSa for submitting fabe Inrernrtbn, IV <br />SIONATURE OF PRINCNAL EXECU <br />R AUTHORIZED AOENT <br />IC A A <br />NUMBER <br />YEAR <br />MO <br />DAY <br />TYPED OR PRINTED InriudlnE the possibility of fine and Imptisonment for knowing eiulatlom OFF <br />ER O CODE <br />COMMENTS AND EXPLANATION OF ANY VIVLA1I IvnZo imererance an <br />.BLE SOLIDS LIMIT APPLIED FOR =IOYR,24HR PRECIP EVENT- <br />LDS MONITORING - I. B. 2. - - <br />- -- <br />f ?----- This +s a 4-pan form r"?t p? <br />. <br />I` EPA Form 3320-1 (Rev. 3199) Previous editions may be used Th