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PERMITTEE NAME/ADDRESS (7eer. F.rrg N..?Lerafen (/D?i..mr) <br />NAME <br />ADDRESS <br />LiUA 1. ,Zj; <br />IG CO 81626 <br />FACILITY . -?f-,PPER MINE <br />LOCATION : R A I G CO 81625 <br />RAYMOND G. DU BOIS) PRES/GM <br />NATIONAL POLLUTANT DISCHARGE EUMINATION SYSTEM (/NPDES/ <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YE O DAY YE O DAY <br />FROM TO <br />Form Approved <br />OMB No 2040-0004 <br />MINOR <br />(SUBR JC) <br />F - FINAL <br />POND #10 TO JOHNSON GULCI <br />MOFAT <br />NOTE: Read Inetrvctlor» before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREOUENCY <br />OF SAMPLE <br /> EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />MEASUREMENT - •; C <br /> PERMIT >< ta. 1 <br />l REQUIREMENT M I N I !?!.. MAXIMUM <br /> SAMPLE <br />MEASUREMENT <br />1 <br /> <br /> PERMIT <br />`)ALi i REQUIREMENT 30DA AVM DAILY MX ?UT'F <br /> SAMPLE <br />MEASUREMENT <br />_ <br /> <br /> PERMIT r r i t <br />_??E! . t (_ I? ,. • _, ', REQUIREMENT 30DA AVER DAILY MX MONTH <br /> <br />AS FF SAMPLE <br />MEASUREMENT <br /> <br /> PERMIT .. , , . _ ,: - 1 <br /> REQUIREMENT >'?tA A V G DAILY MX r:itNT. <br /> SAMPLE <br /> MEASUREMENT v ,,- <br /> <br />32 1 PERMIT t <br />_ UEN REQUIREMENT i NST MAX 'N T <br /> <br /> <br />J TRErI i•7-I-i i SAMPLE <br />MEASUREMENT <br />/ 1, <br />j , <br />? <br />`•O 1 0 G PERMIT _ f I <br />-NT REQUIREMENT 30DA ?':..Y MX <br /> <br />LVED SAMPLE <br />MEASUREMENT <br />i a <br />. - <br /> PERMIT - ... <br /> REQUIREMENT JA AVG DAILY MX <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER t molly " r penally ° law that this document and sM attachments were TELEPHONE DATE <br /> pra•parvd under my dlreciton -sup-I " In sccordann with • system deigned <br />- to tart that qualified Personnel Property gather and evaluate the Information - - <br />(I ,Jn submitted. Bared on my Inquiry ar the person or Persona who manage to system, <br /> or lhoae <br />erso s directl <br />res <br />onsible f <br />r <br />th <br />i <br />I <br />th <br />f <br />t <br />t <br /> P <br />y <br />p <br />o <br />er <br />ng <br />e <br />n <br />ga <br />orma <br />on, <br />he information <br />-- <br />/- C submitted I& to the best of my knowkdte and belief. Ime. a -W and comptele. <br />t .n,...r. th.f there art drnifl-l pen.Itt, fur mhmifffnt f.tv Infnr.rh.tlon - <br />SIONATURE OF PRINCIPAL EXECUTT IE ..:, 'far (-J <br />/ <br /> <br />TYPED OR PRINTED OFFtcER OR AUTHORIZED AGENT COOS NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLA I IONS (Reference N/ effechments here) <br />Ti_FADLE SOLIDS LIMIT APPLIED FOR <"=10YR, 24HP PRECIP FVENT- <br />EPA Form 3320-1 (Rely. 3199) Previous editions may be used. COO37 / 01?kql"4'IP91+4rm. PAGE lOF <br />-----------------