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PERMITTEE NAME)ADDRESS pnab,& f eateyNww?Ioertm (fD(QWwo) NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPOES) <br />NAME DISCHARGE MONITORING REPORT (DMR! <br />ADDRESS ?'r11 v . ; L L_ r1 n )? '`1 I !'ti L. <br />BOX 535 PERMIT NUMBER DISCHARGE NUMBER <br />-:RSET CO SMONITORING PERIOD <br />FACILITY ;:TORN CRK 8( ELK CRK MINES YEAR MO DAY YEAR MO DAY <br />LOCATION F!SET CO B14 FROM TO : <br />MFF T rnnPFR. FYFC V P <br />Form Approved. <br />OMB No 2040-W <br />MINOR <br />(SUBR MI-f) <br />E - FINAL <br />SEDIMENT POND TO ELK CREEV <br />NOTE: Read Instructions before 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 />M <br />rj 7rS <br /> MEASURE <br />ENT <br /> PERMIT ## ti ### #+r# ms's t< b._ ###### 9. 0 <br /> REQUIREMENT r "' 1 I, ??•; <br />MAXIM <br /> <br />1°i(il'v t 3 <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ###sE+I# sI?#3.IE# ##I?It+! 70 I l <br />j-i REQUIREMENT V DAILY MONTI <br /> SAMPLE - ?_• `, <br /> MEASUREMENT <br /> PERMIT ###### #####> it##i?## REPORT REPORT NCE/ ;RAP <br /> REQUIREMENT 30DA A`1C DAILY MX MONTI- <br />„ SAMPLE <br />FiS r MEASUREMENT r .. <br />r. ( V PERMIT ##### ##3f#il t? ##Ir### 3000 0000 UNCE/ GRAD <br />, <br />per. REQUIREMENT 30DA DAILY Mx MONTH <br />RFA`.; <br />t SAMPLE <br /> MEASUREMENT <br /> PERMIT x 1 ni :";: „s 1D ONT11\ ':. <br /> REQUIREMENT INST I`1f,X C?:T <br />{ SAMPLE <br /> MEASUREMENT <br /> PERMIT REPOR : %T <br /> REQUIREMENT jrlA MY <br /> SAMPLE <br />SUREM <br />NT <br /> MEA <br />E _77 <br />PERMIT +#i REP ##? :+ ?- ##*x 7 AT <br />IN C E <br />REQUIREMENT ; 1^•T MAX :. <br />NAMElTITLE PRINCIPAL EXECUTIVE OFFICER I rertily under Pens ry o hw ins thh document ¦nd .11 atlochments were <br />TELEPHONE <br />DATE <br />prepared under my dlracibn or fuPerv4rlon In .aurdance with a system designed <br />-- to .sure that qu.Mr d personnel properly gsthar and e. W ale the Information <br />d on m <br />I <br />ulr <br />or the <br />wh <br />man <br />itted <br />B <br />erson or <br />erson <br />th <br />t <br />b <br />y <br />y <br />ge <br />su <br />m <br />. <br />re <br />" <br />p <br />p <br />s <br />o <br />e sys <br />em, , <br />r• <br />or thaw persons directly responsible for gathering the InFornuillon. the into don <br />?"- submitted K to the best or my it w ge and belief, true. accur.te• and canplele. - <br />4I0NATURE Of PRINCIPAL EXECUTIVE <br /> <br /> <br />_ - <br /> 1 am aware that them on significant penalties nor submitting false Infonmedow• <br />TYPED pRpfTIEp Including the poadblMty or fins and Imprisonment nor knowing .lel.tloni OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference aM arrechmanrs hare! <br />SOLIDS I MT flr?; TrD FOR ?'?HR FF}t_rrp r. i.;rt•.'T <br />' r . ?_ - t'1 __ ?+ - rn'V / 1'Li6{? r - r Irt+-? I+? I M? ?T " r (• - <br />EPA Form 3320-1 (Rev 3199) Previous editions may be used. 1 TINS is a 4-Pan form. PAGE OF