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FERMITTEE NAME/ADDRESSII.rA.&Faroty N..?L.raefowl(D(Q6wv) <br />NAME <br />ADDRESS j <br />)NIA CO 8142E <br />FACILITY , I E NO. 2 MINE <br />LOCATION 441A CO 8142E <br />LLIAM A. BEAR JR., MINE MGR <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDESI <br />DISCHARGE MONITORING REPORT ID R! <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />Y R MO DAY Y R O D Y <br />FROM TO <br />Form Approved. <br />OMS No, 2040-0004 <br />(SUB.", <br />F - F- : lt,4AI DELTA <br />NOTE: Reed k»tructions before compisting this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREOUENCY SAMPLE <br /> OF <br /> EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />- <br /> MEASUREMENT ? <br /> :- tJ <br /> PERMIT _ <br />?Sca REQUIREMENT MINIMUM MAX IMUM <br /> <br />_ SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT ". , - , ... <br /> REQUIREMENT 3cjr)A A`,:'-- i -`.. L'{ MX 111ON H <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT _ <br /> REQUIREMENT r 30DA r+'v" DAILY MX NONTH <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT -W 14 <br />.4 i v <br />F7 i REQUIREMENT I NST MAX GEN. T <br /> SAMPLE - <br />ih> r" MEASUREMENT <br /> PERMIT - <br /> REQUIREMENT -=C!DF= .IL_`` MX <br /> SAMPLE <br /> MEASUREMENT <br /> <br />1 O PERMIT K to 0K r <br /> REQUIREMENT : , SST MAX <br /> <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br /> <br /> <br />a <br />under <br />pars. <br />° <br />I. <br />w <br />that thh <br />docu <br />document and <br />all <br />' <br />NAMErrinE PRINCIPAL EXECUTIVE OFFICER <br />TELEPHONE <br />e <br /> <br /> <br />ATE <br />with a designed <br />nce with system sn <br />un <br />der my <br />dl <br />rec <br />llon <br />wpen <br />Mon In <br />prepared <br />M <br />aecord <br />to sta re that quaMfled personnel Properly rather and rraluate IM Information <br />¦ <br />b <br />ilt <br />d <br />d <br />I <br />i <br />of th <br />B <br />o <br />m <br />e <br />ase <br />on my <br />nqu <br />ry <br />. <br />e parson or persons who nsanage the system, <br />or Chow persons dimity responsibie for pthrrtng the Information, Ike Information <br />submitted I& to the best of my knowledge and belief, true, a rale, and complete. <br />I -...n that them an sirn111-t penaltles /nr nhmttting r.Iw Inrn ,nainn <br />SIGNATURE OF PRINCWAL EXECUTIVE ?. <br /> . <br />l <br />d i <br />n <br />A <br />l <br />1 <br />1 A <br />A <br />TYPED OR PRINTED n <br />ud <br />- n <br />mpntso°mrnt <br />ng the poadbluty . <br />1 <br />or ?no.inr .tol.un n OFFICER OR AUTHORIZED AGENT NUMBER <br />COD <br />E YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS /Reference ON attachments hers/ <br />T NSTRUCT I ONS - I. C. 1 O. PG. 10 <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. br js, 8 4-part form PAGE