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PERMFTTEE NAMEIADDRESS(7w"f«vMryN&.?L«.si w(/D(Qbnu) <br />NAME <br />ADDRESS <br />!. BOX 151 <br />?TIG CO 81626 <br />FACILITY APPER MINE <br />LOCATION A I G CO 81625 <br />=,YMOND G. DU BOIS, PRES/GM <br />NATIONAL POLLUTANT OISCHAAGE ELIMINATION SYSTEM fIWDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER ascHARGE 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 MOFAT <br />DSCHG TO E. MIDDLE FLUME GULCH <br />NOTE: Read ktetruetlons beftxs completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. <br /> <br />EX FREQUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> <br />_ PERMIT REPORT ##k = =ifit'-. < r: s#i1# r = <br /> REQUIREMENT INST MAX t-: <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 /> <br />I certhte " er penalty ° Isw that this ml <br />dacurM and sit .ttachments were <br />ned TELEPHONE <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER <br />dir <br />ti <br />erslslow In <br />with a s <br />stem desi <br />re <br />r <br />d under m <br />n or s <br />d <br /> <br />DATE <br />p <br />pa <br />e <br />y <br />ec <br />o <br />up <br />accor <br />ance <br />y <br />g <br />to inure that qualified personnel properly galber and e,atuate the Information ?' - <br />f submitted. Bred an my Inquiry of the person or persons who manage the system. <br />' •' <br />'? ?? <br />? <br />? <br />t?i <br />or those persons direciy responsible roe tethering the Inrornaten• the Information <br />( <br />/ <br />'' - ' .. . <br />. <br />submitted b>, to the best of my knowledge and belief. true, ecturale• and complete. - <br />GIGNATVRE OF PRINCIPAL EXECUTIVE - <br />? <br />` _. <br />- t am aware that there are slgnltlcant penalties for srrbmdtting ram InformatkM A WA <br />TYPED OR PRINTED Inctuding the possibility or flne and Imprisonment for knowing elolatlors. OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLA I IONS (Reference sir erracrfmenrs here) <br />;-ABLE SOL-IDS LIMIT APPLIED FOR !=10YR,24HR PRECIP FVENT- <br />_ TOR It?i. <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. _ , ;r D*sj$.a 4-pavrtform. PAGE OF