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KAMITTEE NAME/ADDRESSpwh-&FwWyN..?Lora,enl(D(f-o,r) <br />NAME <br />ADDRESS <br />J. BOX 18 <br />A I G <br />CU s1' <br />FACILITY ,-UPPER MINE <br />LOCATION A I G C-0 81 i! <br />rYMOND G. DU BOIS, PRES/GM <br />NATIONAL POLLUTANT DSCHAROE ELIMINATION SYSTEM NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NLINISER <br />MONITORING PERIOD <br />YEAR MO DAY Y AR MO DAY <br />FROM TO <br />Form Approved <br />OMB No. 2040-0004 <br />MINOR <br />(SUBR <br />F - FINAL NOFAI <br />DISCHARGE TO FLUME GULCH <br />NOTE: Reed Instructions before completing thle form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. <br /> <br /> <br />EX <br />OUENCY <br />FRE <br />OF <br />SAMPLE <br />TYPE <br /> ALYSIS <br />AN <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />MEASUREMENT <br /> <br /> PERMIT 1 # it rl it t #sF# 2 s#YFfi?tii k ##sl #it# _ , <br />R'... REQUIREMENT i NST MAX - C:, :.. <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 /> 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/TtTLE PRINCIPAL EXECUTIVE OFFICER ' "el"y under Pen¦ Iy nr1a. that thh document and all Iiwhmenu were <br />PRpared under eny direction or -p,r.tA, In accordance with a ayatem desltned TELEPHONE DATE <br /> I* a"'m that qua iI'd penonnei PmWY tether and eeMuate the Inroevnatlon <br />fobm111ed. Based en my inquiry or the person or persona who manate the a <br />ftem : <br />? <br />-- -' <br /> y <br />, I <br />c <br /> or Ihoae persons dlrecoy reepondble ror talheAnt the Information. the larortnet{on <br />I <br /> Submitted K to the best or my tnowtedte and beW, true, eemmir. and compktt _ .. _. <br /> I am ¦.am Met then - rltnincant penatrim I- rubmittln <br />W- Infnrmarkn SIGNATURE OF PRINCIPAL EXECUTIVE <br /> t <br />, AKA <br />TYPED OR PRINTED InAudint the podblutr of nnr and Imgrtronmem for k-inr ic4atlo a OFFICER OR AUTHORIZED AGENT CKE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference ell attachments herel <br />L f'An! '13Cl+._ IDS LIMIT APPL_IFD FOR --14H? !rPFC=P FVT-= )T_ <br />r_; A \ ; I Serf hrY? PAGE of <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. ?T>?a_ p?rfprm. -?