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PERMITTEE NAME/ADDRESS(7m&*Fw&dy )vasaa/Leeae,a i(D406"w) <br />NAME <br />ADDRESS <br />-i. Bux 187 <br />^,IG C70 82626 <br />FACILITY `,PPER MINE <br />LOCATION ; I G CO 8162S <br />YMOND G. DU BOIS, PRES/GM <br />NATIONAL POLLUTANT DISCHAROE ELIMINATION SYSTEM INPOES/ <br />DISCHARGE MONITORING REPORT (O-R) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM I - TO <br />Form Approved. <br />OMB No. 2040-0004 <br />MINOR <br />(SUBR JC) <br />F - FINAL MOFAI <br />DISCHARGE TO DEAL GULCH <br />'.t R i- Y I <br />NOTE: Read kwtructlorw Wore complotbW this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. <br /> <br />EX FREGUENCr <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYMS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE _. r <br /> MEASUREMENT <br /> PERMIT sf##ific# REPO C; ? .. riL <br />t <br />REQUIREMENT <br />I NST MAX <br />MON <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT U <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT / <br /> REQUIREMENT C' <br /> SAMPLE <br /> MEASUREMENT 1 <br /> PERMIT <br />REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />NAMEmnE PRINCIPAL EXECUTIVE OFFICER I nrlny a r pent ° law InN Ihb document and all attachments wen TELEPHONE DATE <br />prepared ender my direction or supervision In accordance with a syslern darned <br />. to aawn that qualined personnel properly gather and evaluate the Informalon <br />b wbmltted. Bested on my Inquiry of the Parson or person who manage the system, <br />- or those penan dlreclly mponslble for gathering the Informauaa, the Information <br />wbmllled is, to the bnt of my knawiedge and better, Irve, accvnle, and complete. <br />SIGNATURE OF PRINCNAL EXECVTNE <br />t <br />i <br />l <br />I <br /> I am were that then are slgnlllcaa <br />penalt <br />es for wbtWtdng fa <br />se <br />nformation, <br />TYPED OR PRINTED Including the possibility of fine and ImpAsonmmt for knowing vblatltsm OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION yr ANY VIVLA I IVN5 r/r1/Nlnce an arracnmants naral <br />_ ::.ABLE SOLIDS LIMIT APPLIED FOR <=10YR,24HR PRECIP EVENT- <br />- i-DS MONITORING - I . B . 2. <br />PAGE OF <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. _J 698 / ,' ,T7F3??_, ?4-I?a{4Tm- <br />_ ? -