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PERMITTEE NAME)ADDRESS paeb6Foa*,y Ma.WL[ Yea. ((Dif-0) <br />NAME <br />ADDRESS _ <br />I3OX 483 <br />{IA CO 8142 <br />FACILITY ' E NO. c MINE <br />LOCATION i. T A ?. 014 2 <br />.. ;_LTAM A PFAR JR MINE MGR <br />NATIONAL POLLUTANT D(SCHAR0E ELIMINATION SYSTEM (INPOESI <br />DISCHARGE MONITORING REPORT (OMRI <br />PERMIT NUMBER DISCHAAGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved <br />OMB No. 2040-0004 <br />MINOR <br />(SUBR MH) <br />F - FINAL DELTA <br />SR; DEER TRL DTC OR UNMD TR1B <br />NOTE: Read Instruction before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREOUENCr <br />SAMPLE <br /> <br />EX of <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT a #z :: t EEK, Y '1 rt. <br /> REQUIREMENT I- j ;- X I MUM <br /> SAMPLE <br />1 MEASUREMENT ^ <br />:? 1 PERMIT : #3 air## .. it , C / -RA <br />(-1>_T.IT V? <br />REQUIREMENT <br />A`•%(' <br />Uf i l 't hi Y, <br />MON-;r•u <br />- SAMPLE <br /> MEASUREMENT <br /> PERMIT ;: ttt#?t {t.? tt#tr# ::, a # s: REPCK EPC? T <br />JL N I' REQUIREMENT 30DA t1V(- nfi ILY MX MONTH <br />rr SAMPLE <br /> MEASUREMENT <br />T PERMIT of Yc##:: ;. #??? "t # #it#iE## :3000 000 NCE/ A <br /> REQUIREMENT 30DA ':,111_Y Mx MONTH <br />r? '. SAMPLE <br /> MEASUREMENT <br /> PERMIT 10 <br /> REQUIREMENT INST MAX C.7 , <br />f !:(I IJDU. SAMPLE > I <br />r =ATMENT r MEASUREMENT <br /> <br />0 r, <br />PERMIT <br />REPORT <br /> <br />REPOF?I <br /> <br />.. I_ r <br />I AN <br /> <br />N -. i <br />.; . ; r REQUIREMENT DA I L': <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT r..u.uir Ai=r s4 f" , - _ A., .. <br />_ L_77177-77C <br />REQUIREMENT <br />? , ;:- '" ":=•,.?. <br />NAMEITITLE PRINCIPAL EXECUTIVE OFFICER I mrt,fy and" penalty o a. that thh docan.nl and .b .ftar3,menu weee TELEPHONE DATE <br />prepared under my dlrertlon or supenflon In accordann with ¦ system designed <br />to dart that quallRed peraonnei property gather and e,aluale the information <br />salsmilled. Based on my inquiry of the person or persons who mseeage the system, <br />or float peratme cHmelly responsible for gathering the Informallm the Information <br />submitted K to the best of me it" ge and belief, true, accurate. and complete. <br />"'- I a <br />..am th <br />nifleaal <br />GIONATURE OF PRINCIPAL EXECUTIVE <br />t the <br />si <br />en <br />lti <br />for <br />bmilnn <br />( <br />l <br />Inf <br />id <br /> m <br />a <br />re am <br />g <br />p <br />a <br />es <br />m <br />g <br />a <br />ai <br />orma <br />el• <br />TypED OR PRINTED Including the possibility of one and Imprisonment for knowing Oolauom OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (RI/arence all attachments heral <br />EPA Form 3320-1 (Rev 3/99) Previous editions may be used This IS a 4-Pert form. PAGE OF