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pEAmiTTEE NAMEIADDRESSpneYlrF-4htyNmw?L .tin l(Dt#b.wu) <br />NAME <br />ADDRESS <br />BOX 187 <br />?G CO <br />FACILITY :'PER MINE <br />LOCATION ' G CD <br />rMOND G. DU BOIS, PRES <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM_ fNPDESI <br />DISCHARGE MONITORING REPORT IDMRI <br />PERMIT NUMBER ascHAME NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />B 1 FROM TO - <br />QM <br />Form Approved. <br />OMB No 20404004 <br />MINOR <br />(SUBR •JC ) <br />F - FINAL <br />DISCHRG TO FLUME GULCH <br />X <br />NOTE: Read kNtructlone bofwo "completlrtp this form. <br /> <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREOUfNCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT at # ## t 7F--C) RT sr## k sc Ir s #if it r#### EL i <br /> REQUIREMENT i NST MAX <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ' <br /> REQUIREMENT / <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />/ / <br /> REQUIREMENT <br /> SAMPLE I. - <br /> MEASUREMENT ?- <br /> PERMIT <br /> REQUIREMENT i <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 />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I -rimy under pens ly n law that Ihh dorumenl and all attachments were TELEPHONE <br />direction or <br />er.hlon In oc <br />ur one* with . e <br />.lem dd <br />ned <br />d <br />d DATE <br />y <br />er my <br />mp <br />c <br />g <br />pnep.re <br />un <br />to aaure that quamned personnel propeAy gather and evaluate the Infarrrlatlon <br />submitted. Rated on my Inquiry o (the person or persons who muuge the "em. r <br />? .. <br />ble r <br />t <br />th <br />t <br />t <br />i <br />h <br />f <br />I <br />f <br />\1/ h <br />1 <br />' <br />y rnpond <br />« ga <br />her <br />ng t <br />e In <br />ormation, <br />he <br />n <br />o <br />m <br />- <br />or those persons direcl <br />. <br />•' <br />k ' <br />ge and belief. trw..cevnte. and complete. _ <br />submitted K to the best of my It loo <br />SIGNATURE OF ?RINCMAI EXECUTIVE _ <br /> I am awan that then are Wofkant penalties for submitting valor inrormadon. AREA <br />ER <br />Y <br />TYPED OR PRINTED Including the paaibiny d nne and lmpMunmrnt for knowing vioi.Holaa OFFICER OR AUTHORIZED AGENT CODE NUMB EAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS IRI{NInCI M atrscnmantS norel <br />-,DLF sm_TPE LIMIT APPLIED FOR =10YR, 24HR PRFCIP FVENT- <br />Ec4 Form 3320-1 (Rev 3;99) Previous ed,hons may be used This is a 4-pan form PAGE OF ?'t