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PERMiME NAME/ADDRESS 17ne64 ferWryNarr/Lser aw (JD(elwwvJ <br />NAME ' ..!' <br />ADDRESS <br />LOX l8i <br />IG CO 81626 <br />FACILITY P P E R MINE <br />LOCATxNi I G CO 81625 <br />YMOND G. DU BOIS, PRES/GPI <br />NATIONAL POLLUTANT DISCHARGE EUMINATION SYSTEM NPOESI <br />DISCHARGE MONITORING REPORT /O R/ <br />PERMIT NUMBER asCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO OAY YEAR MO DAY <br />FROM TO <br />Form Approved <br />OMB No 2040-0004 <br />MINOR <br />4SUBR JC) <br />F - FINAL <br />WEST TESTING FOR 021A <br />MOFAI <br />NOTE: Reed ImtrucNaw before completing this fwm. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREOUENCY <br />OF SAMPLE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE <br />E SAMPLE <br />MEAS <br />M <br />NT z ?- <br />i-fN T URE <br />E <br /> PERMIT ## s ### 100. Ut: ; ## fiiF## 3 <br /> REQUIREMENT <br />MN VALUE <br /> SAMPLE <br />MEASUREMENT <br /> <br /> PERMIT # r # a +t lS st z rf tf 1 GO. 0001 pit #Y r r= #at lr# Y G RI <br /> REQUIREMENT MN 'JA Jc <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br /> <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/TITLE PRINCIPAL EXECUTIVE OFFICER I ceruty antler pet e y o Isw that this dot omens and all attachments were <br />prepared under my dlrsrtlon or supenklon In accordance with a system designed TELEPHONE <br />DATE <br />to inure that qualified personnel property gather and ecaiuete the Inforsnualon <br />?i /..._ submitted. Based on my Inquiry c(the person or persons who me tage the system. . <br />- <br />or there persons dlrerty responsible for gathering the Informatim lbe Inforrtitlon VN-- <br />submitted Is <br />to the bet of m <br />knowled <br />e and b <br />e <br />f <br />tr <br />t <br />d <br />, <br />y <br />g <br />e <br />e <br />• <br />ue, accura <br />e, an <br />complete. <br />I am aware that then are sigrdfkatN pendfks for subndtting faker Infornrdon <br />SIGNATURE OF PRINCIPAL EXECUTIVE .. <br />TYPED OR PRINTED - . <br />Imiuding the poaaibllly of Brae and imprisonment for knowing rblatlorsi OFFICER OR AUTHORUEO AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS /Reference all eftechments here/ <br />?E c FP?I !.r r(? - STATISTICAL POINT ESTIMATE !-,';-' <br />REF" ;? - IL,. Wi!i :; !;. T 11• <br />-_ ` _c f <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. _ _hiI , -fp-?b9-panfiQrw PAGE AF <br />- - 1