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PERMITTEE NAME/ADDRESS(y-"FecOyNo.WL r.ri-(/D(fe t) <br />NAME <br />ADDRESS <br />Lux 'idj <br />4IA CO 8142 <br />FACILITY I E NO. 2 MINE <br />LOCATION 'J I A C G 8142 <br />..LIAM A. BEAR JR., MINE MGR <br />G-,?? RE D FormAppro.ea <br />NATIONAL POLLUTANT DISCHAAGE ELIMINATION SYSTEM (( PD Sl RECEIVED 3M8 No. 204--00 4 <br />DISCHARGE MONITORING REPORT (DMR) <br />SUB' MAR 2 7 2009 ?- Q <br />PERMIT NUMBER DISCHARGE NUMSER ' -- P I NAt_ t r <br />/MINE Rivkin UREigla+il§tion,DTC; H <br />MONITORING PERIOD Mining and Safety <br />YEAR MO DAY Y R MO DAY <br />FROM TO <br />NOTE: Read kIstructlone Wore completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREOVENCY SAMPLE <br /> OF <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE <br /> SAMPLE <br /> MEASUREMENT <br />_ PERMIT ,, <br /> REQUIREMENT M 11,41 Ili, JM MAXI MUM <br /> SAMPLE <br />MEASUREMENT - <br /> PERMIT ;M All <br />- - .78! REQUIREMENT 3??r,r ,'•,; : DAILY MX NIONTH <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT PRE! I" OR I KI!l OR 1- , . <br />. <br /> REQUIREMENT DA Air DAILY MX MONTH . <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br />,INT C.'Rl': REQUIREMENT 30DA AVG DAILY MX '. 100TH <br />.? SAMPLE x ; <br /> MEASUREMENT <br /> <br /> PERMIT 1 , <br /> REQUIREMENT I NST MAX _ <br />GENT <br /> SAMPLE - <br /> MEASUREMENT <br /> <br /> <br /> PERMIT . <br /> REQUIREMENT -A AV DAILY MX <br />_ SAMPLE <br /> MEASUREMENT <br />- <br /> PERMIT <br /> <br />REQUIREMENT <br />;,diST MAX <br />_ :. <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER I "nay r pease ty c aw that thh document and all etl.rhments were <br />re <br />ared .nd <br />dl <br />l TELEPHONE <br /> <br />p <br />p <br />ee my <br />rert <br />on a supr. w " in accordancewith a sysleen designed <br />t <br />h DATE <br /> o asun t <br />at quOilled personnel p operly galher and ...J ate the InIm nui loo <br /> vubmltled. based on my Inquiry or the person m persoru who menage the system, <br />or those <br />e <br />dir <br />tl <br />res <br />r <br />ibl <br />r <br /> p <br />rson <br />ec <br />y <br />po <br />u <br />e <br />oe gathering the Information, the Inronmllon <br />b <br />ill <br />d h <br />t <br />th <br />b <br />l <br />r <br /> su <br />m <br />e <br />, <br />o <br />e <br />n <br />o <br />my knowledge and beW. Ime, it vrale, and complete. <br /> t am aware that then are ognllkaat Penalties ror wtbmiliti <br />ht <br />Inr <br />l SIGN <br />T <br />P <br /> ng <br />: <br />osmat <br />on, A <br />URE OF <br />RINCNAL EXECUTIVE <br />TYPED OR PRINTED <br />r.a.a aea„•n aa,n <br />evot •uATlnu nC •NV Vlnl Includint the possibility or one end Imprisonment For knowing .lolallotd <br /> <br />•Tlnkle .______ OFFICER OR AUTHORIZED AGENT AREA NUMBER <br />CODE YEAR MO DAY <br />I_Ih1 i_IES ONLY IF HR PRECIP EVENT IS CLAIMED. IF CLAIM APPROVED RY t?1QCD, <br />.7 1 <br />EPA Form 3320-1 (Rev 399) Previous editions may be used <br />Th1S is i 4 -Pan form. PAGE OF