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PERMITTEE NAME/ADDRESSpwdter F.ewry/r..?LxrrenU?IdG•ry <br />NAME "). <br />ADDRESS <br />1. BOX i87 <br />?AIG CO 81626 <br />FACILITY -'APPFR MINE <br />LOCATION t A I G CO 811625 <br />,YMOND G. DU BOIS, PRES/GM <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM //NPDESI <br />DISCHARGE MONITORING REPORT (DMRI <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved <br />OMB No 2040-0004 <br />MINOR <br />(SUBR JC) <br />F - FINAL <br />MOFAT <br />DISCHARGE TO FLUME <br />NOTE: Read b»tructlorw 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 <br /> <br />17 <br /> <br /> PERMIT x ;r -?± ?. 5 9. O !EE LY INSI i i <br /> REQUIREMENT MAXIMUM <br /> SAMPLE <br />E <br />T <br /> M <br />ASUREMEN <br /> PERMIT u•n##? sf?t??#:4 Irat a? st O5 70 !NCF! :;,':,::5 <br /> REQUIREMENT 30DA AVG AILY h10N7 <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT S#3i :: # ###tt ###If+riF OPTIONAL REPORT 'NCE/ ^RAB <br /> REQUIREMENT <br />_ 30DA AVG DAILY MX MEANT <br /> SAMPLE <br />MEASUREMENT <br /> <br /> PERMIT ### z,' r ?4 ##iF# #i! ### 3c) 0 fJ 6000 <br />)N(_ E/ <br />GRAD <br /> REQUIREMENT 30DA AVG DAILY MX MONT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT i i z :. r.q; 2 .. < i O ON I 114 . <br />D <br /> E [ <br /> R <br />QUIREMENT I N, ?i T 1` Pix .. (,SENT <br /> SAMPLE <br />MEASUREMENT I <br />y <br />REA j mhI'•1 ( 1 - ; <br />1 0 O PERMIT REPORT R PORT <br />".UENT G 'ROSE REQUIREMENT _.rDDA AVC. `' AILY MX <br /> <br />? SAMPLE <br />MEASUREMENT <br />O? :LVE <br />_ PERMIT .;..-REPORT _ U7 ,.1 <br />REQUIREMENT ;ODA DAILY MX <br />t crrtdy under pen. 1y o law that this d-arnt and all attachment, wen <br />NAMElTNTLE PRINCIPAL EXECIlTiVE OFFICER prepared under my d1mr1lon or w TELEPHONE <br />pervMon In seeordann with a,yflern designed <br />DATE <br />to .sure that quaened personnel properly Rather and esatuste the Inrormatloo - <br />subradtled. lased on my Inquiry of Use pertsn ac person who manap the syacm <br />, _ <br />or lbose person directly respordb4 for RatherInR the Inrormat{on, the Information <br />submitted K to the best of mr knowrrdp and belle!. true, arcvnlr. and complcle. <br />- I am swan that then are slRnincarnt <br />enatttes for mb-Ittin <br />rake Inrormatlon <br />SIGNATURE OF P RINCNAL EXECUTIVE <br />TYPED OR PRINTED p <br />g <br />, <br />Inch ding the passlblWy of f1m and Imprisonment for kmwlnE Holauorn OFFICER OR AUTHORIZED AGENT AffA <br />CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference eat effachmenfs here) <br />1-_f=.^•1?Li= c3 7+i IDS LIMTT APPLIED FOR 0 <br />OR INr <br />IE 1 n.• GPtI4 1:71 <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used -_ . Tf11 JS A-S-PalZ.fpfTTl. PAGE ,,OF