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FERMITTEE NAME/ADDRESS (7..6 F.,Moy Nw..VL ., . t(Do we) <br />NAME <br />ADDRESS <br />BOX 483 <br />NIA CG <br />FACILITY r E NO. "t ? r ; <br />LOCATION ,IA <br />CO <br />LLIAM A. BEAR JR. MINE <br />NATIONAL POLLUTANT OISCMMOE ELIMINATION SYSTEM (INPOES1 <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NuMeER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />14 '- . FROM TO <br />MG i-, <br />Form Approved. <br />MINOR OMs No 2040-0004 <br />(SUBR <br />F - FINAL. DELTA <br />5R I DEER TRL DTC OR UN11D T R I G <br />NOTE: Reed k»trucdom before completh+y thle form. <br /> <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> [>< OF <br /> EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT :rx# i ! 'EEKLY Fv <br /> REQUIREMENT X I PiUI`i <br /> SAMPLE <br />MEASUREMENT <br /> <br /> PERMIT #F ti zrz ?r ? r. -7 fit •35 7_7 RA _ <br />i i VALUE. REQUIREMENT u111 <br />vL`A AIV;G <br />1LY riX <br />i•ii?Pi1N <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />#ii# <br />#fi3r#r?ir <br />fie#:<r... <br />REPORT <br />r ; <br /> REQUIREMENT 30DA AVG DAILY <br /> SAMPLE <br />• MEASUREMENT <br />I PERMIT ##### s r ## # #3f tE fF 00 6000) = :` F2 <br />1-i-L, IF REQUIREMENT _30DA AVG DAILY H PiONTH <br />I L ,;) SAMPLE <br /> MEASUREMENT <br />a `•3? 1 0 PERMIT ###### tF###! # # < sr3i Y x rt ## x 1 n (', : 7•; -i- _ <br />UENT ;ROSS REQUIREMENT AST MAX <br />1 N CONDUIT L" SAMPLE , . :- <br />TRFp.TMENT QI_,; MEASUREMENT <br />0 0 PERMIT REP OF,' REPORT u,:.}. kii###dr + ? _, ?;I' <br />- ROSS ?.1-• REQUIREMENT _;,?GA t, 1ILY MX <br />EASE SAMPLE r #". t t <br /> MEASUREMENT <br />PERMIT .-I;•#ii# ? -,_ I.- <br />REQUIREMENT , ;'- <br />-mty . jj9j, Pen. Fly o .w the[ this cl, * w'I end all .tt.chm is wen <br />NAMERTTLE PRINCIPAL EXECUTIVE OFFICER <br />TELEPHONE <br />A <br />DATE <br />PRPared antler my di-6- ne sttper. <br />- In eccord.nre with . system dedg.ed <br />ID 410%t" that qualified penonnel prupe.+y ether and erda.te the Inro.,n.twn <br />' <br />sebmttted. Stand on my Inquiry of the person or person, who menage the system. <br />a those peme a directly mspa nfbfe for gathering the Inf mnauon• the Inronreuon <br />subnrtted Is. to the best or my kmwYdge and beW, vee..csvrate, and complete. <br />I em swan that there are signlflnnl penartles for submttet.g rN= Inforntatlow <br />SIONATURE OF ?RINCNAL EXECUTIVE - -> - <br />TYPED OR PRINTED • <br />Inrfudl..g the possibility of floe and Imprtsonwent for knowing W*Uw OFFICER OR AUTHORIZED AGENT CAE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS /Reference aM attachments here! <br />• - TMt:-M T-: rI ,,Ttii n=.P°r1^l?Gr, n <br />EPA Form 3320-1 )Rev 3/99) Previous editions may be used This is a 4-Part form. PAGE OF