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PERMITTEE NAME/ADDRESS(7,w"FwgoyNmm?Latarfaw(fD(Qbw) <br />NAME <br />ADDRESS <br />BOX 463 <br />)NIA CO @1426 <br />FACILITY ; I E NO. 2 MINE <br />LOCATION ; r-a I A CO 81428 <br />;I I TAM A R FAR AR . M T NIF Mr-'R <br />NATIONAL POLLUTANT DISCMAHOE ELIMINATION SYSTEM //NPDESI <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />- -. =oaroved <br />''sP 'r:, 2040-0004 <br />MINOR <br />(SUBR MH) <br />F - FINAL DEt <br />CHRONIC WET TESTING FOR 006A <br />NOTE: Read ktetructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. <br /> <br />EX FREOUE14CY <br />OF SAMPLE <br /> <br />YP <br /> ANALYSIS E <br />T <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT 1 ##iF## REPORT Far#### ?t?tit## Tilt firir'-_ <br />?J REQUIREMENT SINGSAMP <br />P •, SAMPLE <br /> MEASUREMENT <br /> PERMIT _-t at at?at 1:1C? :riF:r? , a x# #x CTRL - <br /> REQUIREMENT MN "AL_ i= <br /> SAMPLE , <br /> MEASUREMENT <br /> <br /> PERMIT fat ##at #it#### - PE Oi at #?f# a a '. ' sc# ': # , I'RLY <br /> REQUIREMENT SIf468 4 P r uG ?f''/.? r "?7? <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT :? ;: 'i # tt # IS lF?E 313E i C1C? ,. it it #iFiMit3tit TRL'f <br /> REQUIREMENT ?Vt (1E <br /> SAMPLE <br />tJf1ri: •i i ri Gt ih, <br />? MEASUREMENT <br />F' (' n PERMIT R Ef:' OR 1' <br /> REQUIREMENT S I rNGSA['(f' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - - REPORT <br /> <br /> REQUIREMENT <br />GSr,-ii <br />sill <br />:T <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT REPORT ; 7777 - 'i' 71 <br />REQUIREMENT SINGSW i•' <br />NAMElTiTLE PRINCIPAL EXECUTIVE OFFICER ' feat' y ° of penalty ° low that this document and all sllafhmrmts were <br />TELEPHONE <br />DATE <br />prepared under my direction or wper.hlon In accordance with s system designed <br />to sears that qualned personnel property Lather and evaluate the Information <br />submitted. flared on my Inquiry of the Person or persons who manate the system, <br />d <br />f <br />h <br />or those persms <br />irectly responsible <br />or gathering the Informatlow t <br />e Information <br />submiltted le, to the best of my knowledge and bale(, tnsa, occurate. and complete. <br />w <br />sl <br />lti <br />f <br />I <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />I <br />th <br />t then a <br />df"M <br />b <br />f <br />lti <br />f <br />f <br />ti <br />l <br /> <br />TYPED OR PRINTED p <br />am a <br />are <br />re <br />pena <br />or ata <br />r <br />f <br />ng <br />a <br />se <br />n <br />orma <br />on, <br />a <br />es <br />Including the Possibility or nae <br />, and Imprisonment rot knowing clolatlotss. <br /> <br />OFFICER OR AUTHORIZED AGENT WrA <br /> <br />CODE Nt1MBER <br /> <br />YEAR <br /> <br />MO <br /> <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Refsronce eN attachments hare/ <br />rte{(1?_TS OF LETHALITY nFRIVS Ac "'f' FFcCT", (1R17WTH AN.C <br />T /I C, W P: <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. This is a A.-park >jprm. PAGE OF