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PERMITIEE NAMEIADDRESS P, r <br />NAME <br />r1INE <br />ADDRESS r <br />CQk;id f Y ROAD 130 <br />_•3PTFR05 GO 82326 <br />FACILITY ;•;fs (- t_1AL i1 T NE <br />LOCATION :,PERUS CO 61326 <br />iN RLL,!E i LFS: t MINE ENGINEER ' <br />F>rm Approved <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) w16 No 2040-1-:'. <br />DISCHARGE MONITORING REPORT (DMR) ?I <br />PERMIT NUMBER DISCHARGE NUMBER c 1 <br />MONITORING PERIOD <br />YE 613 MO DAY YEAR MO DAY <br />FROM TO ?, ;... , <br />NOTE: Read In before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREOUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />_ SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />r? r .:n REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAMErnTLE PRINCIPAL EXECUTIVE OFFICER 1 ccruf""'d-Iw•naki or law that thi+drwrmrrut and:dl altarhmrnt. were <br />1 TELEPHONE DATE <br /> Pnpan-d under uq 1111 realm ur +nI>.n isiun in arcnrdani r wlth a +t Hrm tlr.r?tw-d <br />- - <br />r? <br />' la a+•unv thmt quAirrrd pa•mm?ueI PngKrfl ¢.^111-1 aml -111141e the infl-Mi.m - <br />-_ - <br />- <br />,. -• <br />, vlhmiu.vl. Ii-ed oa, m% inyuirn of thr prrmm of prnnn+ w ho mmnayr 11w-t. m. <br />ur tf,- wr-n di-ib "'I..n•.W.- r..r cathenng the iu L.rmaliou. the inrnn alm" --f ? <br />? <br /> ,nul oony>Irlr. <br />In the Iw+t of ut, kurnvledKr and In4Nd <br />Inu• <br />;rrrnr.dr <br />.uhmitlcd 1+ ?'C-- `i'I ?? i ?j ('? <br /> . <br />. <br />. <br />, <br />' SIGNATURE OF PRINCIPAL EXECUTIVE - LJ <br />? <br /> nanl Prytallie+ for .uhwitliak ral 'b-nation. <br />1 am aware that them ire +i€nir <br />FFI <br />R OR AUTHORIZE <br />AGENT AREA <br />TYPED OR PRINTED inrlndin; the Po++lhihn mf rime and nnprr+..m..-1 rot Am.win .i lation,. CE <br />D <br />O CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />-ECIP EVENT SIJI3'.'P'CT '-O 13UP,[)EPJ OF PPOOF REQSVIP.EMENT.9 7''\I <br />TO THE DIVtSi <br />EPA Form 3320-1 (Rev. 31991 Previous editions may be used ??'+{I?'1??rf 4-?tiFft?li?rttl• PAGE OF