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PERMITTEE NAME)ADDRESS (7-6.&F--&k#yNmsWLeuaerow ((D(dW%w) <br />NAME <br />ADDRESS _ <br />]i. BOX 187 <br />'AIG CO 8162 <br />FACILITY 'jPPER MINE <br />LOCATION ra I G C O 9] 62 <br />'iWMOND G. DU BOIS, PRES/GM <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NMES) <br />DISCHARGE MONITORING REPORT ID R) <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 MOF <br />I} I SCHAR GE TO EAST FLUME GULCH <br />x! <br />NOTE: Read k+atructione before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, <br /> <br />EX FREQUENCY <br />OF SAMPLE <br /> <br />E <br /> ANALYSIS TYP <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE . <br /> MEASUREMENT <br />7- <br /> PERMIT OR ##3E## ##### #### <br />ly <br />:•+ <br />71-7 <br /> REQUIREMENT MAX <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT ; 7I T <br /> REQUIREMENT (j <br /> SAMPLE <br /> MEASUREMENT - <br /> <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 I F <br /> <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I renuy under penalty ° low [hot thh dorumrnl and .u Utarhnweu wee: <br />prepared ender m7 dlrsctfon or supervision In areordane< with a syslern designed TELEPHONE DATE <br />?.. to .sere IhN quaBlled personnel pr We. y godw and evaluate the Inrormstion <br />subrnlued. Bred on eery Inquiry o( Ow person or persons who manage the system. <br /> <br />- ar thrr persoru directly respe"ble for gathering Ur Intarvnstlon, the Informalbn <br /> submllted K to the belt or my knowledge and beber. Iroe• acrvrate. end m.plete. <br /> 1 ,a,...... tho there .n d foin<..t Pe,,,lu., fir e„hrnlmn <br />f.l,e SIGNATURE OF PRINCIPAL EXECUTIVE - <br /> r AREA <br />TYPED OR PRINTED -l.ei^t ^r p nenl:u, "' n r •..a i,.,f..",,^^<:,, (^, CrF!cER OR AUTHORIZED AGENT NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS /Reference ION attachments here) <br />r1I'1_t 7rM-TDS LIMIT APPI_IFD FnR 10YR,:14HP PRFCTn ct,.,c <br />TV," T OR ING <br />OT<11. PAGE <br />f <br />EPA Form 3320-1 (Rev. 3)99) Previous editions may be used. ThiSS a4-par OF <br />. _i