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I <br />PERMITTEE NAME/ADDRESS(7-"F-Aty Nm.WLacaltsrt(O(#W%w) <br />NAME <br />ADDRESS <br />I- <br />?!? <br />U i <br />G CO 81 <br />FACILITY 'PER MINE <br />LOCATION TG co 81 <br />"MOND G. DU BOIS, PRES/GM <br />NATIONAL POLLVTANT DISCHARGE ELIMINATION SYSTEM NPOES/ <br />DISCHARGE MONITORING REPORT (D R) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEA MO DAY <br />FROM TO <br />Form Approved. <br />OMB No. 2040-0004 <br />MINOR <br />(SUIIR JC) <br />F - FINAL MOFAT <br />L)ISCHARGE TO WEST HORSE GULCH <br />NOTE: Read Inetructiorle before t:omplet" this fwm. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY <br />SAMPLE <br /> OF <br /> EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT ### ; PORT <br /> REQUIREMENT "46T MAX <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE ?I J <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT / <br /> <br /> SAMPLE , <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE ` <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> <br />PERMIT <br />REQUIREMENT <br />NAME/T1TLE PRINCIPAL EXECUTIVE OFFICER t rervty ° r pen, ty ° ¦w that th11 document and aH allachmente wen TELEPHONE DATE <br />prepared under my direction or wper.ilon In accordance with • ayrlem designed <br /> to more that qualified personnel property gather and evaluate the Information , <br /> submitted. bred orl my inquiry of the Person or person who manage the e"lem, <br /> or those perxro direcily respordbte for gathering the lnform don, the Information -" -, i <br /> <br />- / " submitted I& to the best or my knowledge and belle!, trw, accurate, and complete. <br />r <br /> I am aware that there are dgMNcant penaltle rev rbmflttng Fait Information. SIGNATURE OF PRINCIPAL EXECUTIVE <br />TYPED OR PRINTED Including the poslbutty of Nne and Imprlaonment for knowing eidatlorm OFFICER OR AUTHORIZED AGENT CAE NUMBER YEAR MO DAY <br />vvmmGl\Ia AI\V cnr ??.err.•v.• ... ..... ..??r......... Ir w. w. w....w -1 w.. we...... wrro rrwrw/ <br />?MITS .j?! %- ;• RLE SOLIDS LIMIT APPLIED FOR t'=IOYR, 24HR PRE^_IP FVFPIT- <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. Th1S-J 1,4- (pFI1y, PAGE OF <br />00*79