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PERMITTEE NAME/ADDRESS 17_4.6 FecotyNm dL«ar,ew+(DIQWvw; NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPOE$) <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS <br />Y PERMIT NUMBER DISCHARGE NUMBER <br />FACILITY E INU MINE MONITORING PERIOD <br />LOCATION 'd I A CO 91 YEAR MO DAY YEAR O DAY <br />FROM TO <br />`LIAM A. BEAR JR. MINE MG F, <br />Form Approved. <br />OMB No. 2040-0004 <br />MINOR <br />( UBR MH) <br />F - FINAL <br />NOTE: Reed Irutmetlom before completing this form. <br />LTA <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ, <br /> <br />EX FREOUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT FsF#! # : <br /> <br />( <br />REFIDP <br /> <br /># <br /> <br />? .. .. <br /> <br />1 _ <br /> <br />"1 <br /> REQUIREMENT S I NGSAMP <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 /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />NAMERTTLE PRINCIPAL EXECUTIVE OFFICER I canny under penalty r,WI.. th.tthir dmtma rl and .u .If-h-.ts were TELEPHONE DATE <br />prepared under my dlrrctton or mpe-Woo In aeeord.nm with ¦ System designed <br />to -re that quaNfied personnel ProprAy father and e•oluale the Information <br />submitted. Based on my inquiry of the person or p rooeu who -are the system <br />dbk f <br />th <br />I <br />dl <br />t <br />i <br />th <br />f <br />th <br />f <br />ti <br />or Ihoae persme <br />rx <br />y respot <br />or ga <br />er <br />ng <br />e <br />n <br />omutlow, <br />e In <br />orma <br />on <br />sabrnltted Is. to the best of my it to to and belles, tree. oceurale, and complete <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />. <br />. <br /> 1 am aware that there are dtNltnnt penaMes for submitting !aloe information. AREA <br />NTED Including the possibility of fine and ImprIw ment for knowing Nolallo OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />TYPED OR PRI <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS /Reference N/ attachments Acre! <br />T RESULTS OF !_ ETHAI_. T TY DERIVE AS " %?FFE! T'" , rl?(?W ! ? AND <br />NICH A? ?NI T <br />EPA Form 3320-1 (Rev 3/99) Previous editions may be used - - „; _ This is a 4- rt fo -m. PAGE OF <br />-.