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PERMITTEE NAME/ADDRESS(7teolr*f«+hgN..?Lo m#o tfD(#6vw) <br />NAME <br />ADDRESS <br />LUn kid" <br />'4IA CO 8148 <br />E N0. 2 M I NE <br />FACILITY <br />LOCATION I I A CO 81428 <br />_LIAM A. DEAR JR., MINE MGR <br />Form Approved <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPOES) OMB No. 2040-OM4 <br />DISCHARGE MONITORING REPORT fD R) <br />3UTa -; <br />PERMIT NUMBER DISCHARGE NUMBER ' - F I NAL DEI <br />v L,4TF TO DEER TRAIL DITCH <br />MONITORING PERIOD <br />YE R MO DA YEAR MO DAY <br />FROM TO <br />NOTE: Read kwtrueMons Wors completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, UENCY <br />FREO SAMPLE <br /> O Y <br /> EX ANALYSIS PE <br />T <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />MEASUREMENT <br />t _ <br /> <br /> PERMIT <br /> REQUIREMENT 30DA AV(; DAILY MY LJOL': <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br />OF i•I 1 REQUIREMENT ! NS7 MAX <br /> SAMPLE <br />E <br />=R r" I MEASUREMENT <br />55 <br />PERMIT <br />T 'T -P <br />w <br />? <br />rtt <br />' <br /> REQUIREMENT 30DA, Ak,l' "'>:7DGEOA MONTH <br /> SAMPLE <br /> MEASUREMENT L <br /> <br /> PERMIT r r. _ <br /> REQUIREMENT INST MAX <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER ' Ce^" y under peM I) c (la' ln.. ihi; dervment and atl ¦It"IN = 5 wm <br />TELEPHONE <br />DATE <br /> prepared under my dlrerllon or auprr.hton In a.tordantr with a Intern designed <br /> 1o assure that qu.Mned personnel property gather and ...fuel[ the Infnemallon <br /> submitted. Based on my Inquiry or the parxm w penom who manage the sysbrm, - - <br />- <br /> mr lhase perw directly mpemfbie for gathering the Information, the Inform d" <br /> submtilted h, to the best of my haursrledge and belief, true, arcnrate. and a rmpkle. - r <br /> 1 am .wan that there are slgNnunt peneltty for submllting false Inrormatbn SIGNATURE OF PRINCWAL EXECUTIVE - <br />TE , <br />Includin <br />th <br />dblllt <br />f fl <br />d I <br />b <br />f <br />k <br />D <br />TYPED OR PRIN g <br />e pos <br />y o <br />ee an <br />onmrnl <br />mpr <br />or <br />nowing.iol.Uom. OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS ANL) tArLAr4A l wrM yr ^Fr •I%JLA I tuna lKersrsnce sn arrscnmenrs nsrel <br />INSTRUCTIONS - I. C. 10, PG. 10 <br />EPA Form 3320-1 (Rev 3199) Previous editions may be used r}g ;Y r;Th?s is a.4-part form PAGE OF