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PERMfTTEE NAMVADDRESS(Inc"FecooymmudLocarion(/D(&mu) <br />NAME <br />ADDRESS I i4= <br />BOX 535 <br />__RSET c0 8 <br />FACILITY ;ORN CRK & ELK CRK MINES <br />LOCATION =:RSET CU 8 <br />1CQ T rnnOCC =Y=r W 0 <br />NATIONAL POLLUTANT OISCHARGE ELIMINATION SYSTEM rNPDESI <br />DISCHARGE MONITORING REPORT IDMRI <br />PERMIT NUMBER DISCHARGE NUMaEII <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />L 4 FROM TO <br />Form Approved. <br />OMB No. 2040-Qp04 <br />t`1 I N C? f= <br />{SUBF <br />F - Fir <br />SEDIMEW j,uNJ I U HUDi?ARD <br />NOTE: Read Watrucdorw bolors 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 /> PERMIT ##.# q Est### t; -,. ?. •_: ###### _. •NCE/ INSIT' <br /> REQUIREMENT M r • I1 T MONTH <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT s #### Ir### I• is # u >E# 35 70 NCE,% GRAB <br />:NT G; REQUIREMENT sl;?_?A VG AII...Y I'; : MDNTF <br />Sr. c. I) SAMPLE <br /> MEASUREMENT <br /> PERMIT *#*### ##f!### ##1t# REPORT REPORT NCE/ GRAD <br /> REQUIREMENT 301DA AVG DAILY MX IM".)NTI <br />7 " SAMPLE <br />(AS MEASUREMENT <br />ti + PERMIT #iEiF### +,. r.. .;~ ###### 3S00 1000 rJC''/ CRAB <br />„ REQUIREMENT SODA DAILY Mx : Tt <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT • : : ,.... r ,; ; s,r ! O :CII?I I h R ~i <br />r:'1? J 'vFiL..lt !REQUIREMENT TNST MAX •'JENT <br />[0,4DU I T CiR SAMPLE 3 ) <br />?t.-.. "-,:-NT PL MEASUREMENT <br />O 1 G O PERMIT REPORT REPORT : stv #?r NC / I1':'.• i Ai <br />:.DENT CROSS REQUIREMENT 30DA <br />AND R A"E SAMPLE ??'•: ; <br /> MEASUREMENT <br /> <br />### > tl?iE#iF##ie## <br />PERMIT ###1tREPORT <br />:: <br />REQUIREMENT ; :JST MAX, MON i <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFlCER I nrtrly " r -Pena ty o ew that thh d"mant and nit sttechmenb were TELEPHONE DATE <br />prepared under my direction er wtper.•f it n In aceordence with ¦ systrm ddgmd <br />to assure that qualified personnel property tether and eealua{e the information <br /> <br /> <br />._. <br />- - submitted. Based on my Inquiry of the per or prnom who manage the systern, <br />- r <br />f .' .. <br />the Information ; <br />or those perm directly llspanslble for tethering the Information % % <br />, <br />.. <br />' ,_ <br />c <br />- <br />submitted b. to the ben of my knowledge and Daises, true, accurate, and complete. <br />SIGNATURE OF PRINCWAI EXECUTIVE <br /> I am aware that then an significant penaltie for submitting raw Information. AREA <br />TYPED OR PRINTED Including the possibility of fine and Imprisonment F- knowing rlolHlona OFFICER OR AUTHORIZED AGENT CODE NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS /Re%rence aM attachments hers/ <br />c cr r -2, Lt'1T APrF TFD 1- Ir IO`?'R, 24HR Rqr' TP r l =r,'' <br />_ K. <br />.ferrn. PAGE OF <br />r-'l 14 EPA Form 3320-1 (Rev. 399) Previous editions maybe used. - - n, - _ • ; ??llS f ?.-pa <br />"'- --