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PERMITTEE NAME/ADDRESS(lwbkFmOtyNo.WL«ati w(/D(Qiwwu) <br />NAME <br />ADDRESS <br />BOX 5.35 <br />i"HERSET CO 81434 <br />FACILITY NIBORN CRK &. ELK CRK MINES <br />LOCATION "IERSET CO 81434 <br />:MMES T. COOPER, EXEC V. P. <br />NATIONAL POLLUTANT 04SCHAAOE ELIMINATION SYSTEM WOES1 <br />DISCHARGE MONITORING REPORT W MR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO OAY YEAR MO DAY <br />FROM TO <br />Form Approved - <br />OMB No. 2040-0004 <br />MINOR <br />(SUBR MH) <br />F - FINAL <br />5URF RUNOFF TO N FIB GUNNISOr. <br />NOTE: Read h»tnicdons before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY SAMPLE <br /> OF <br /> EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br />C' ) PERMIT ?E#### REPORT ?.,t ### ###### 'i-y#### NCI/ JIS:)A <br /> REQUIREMENT INST MAX MOr•41-H <br /> <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 />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I "'lay ° r Penalty Ian that this document and all attachments were TELEPHONE DATE <br />prepared under my direrllon w mperetion In accordance with a system dedgriM <br />th <br />t <br />a <br />t <br />ualined <br />e <br />el <br />athe <br />th <br />I <br />f <br />l <br />d <br />l <br />- ?- <br />o aw <br />re <br />a <br />q <br />p <br />rsonn <br />y g <br />r an <br />proper <br />eva <br />uate <br />e <br />n <br />ormation <br />- submitted. Dowd on my Inquiry or the pereoa or persona who manage the systern• J <br />or those penaa directly mponOW for gotherlng the Information. the Information <br />submitted It <br />to the best of m <br />knowled <br />e and b <br />li <br />f <br />U <br />t <br />d <br />l <br />t <br />J <br />y <br />g <br />, <br />e <br />e <br />, <br />we, accura <br />e. an <br />comp <br />e <br />e. <br />` I am aware that there are sigNtkiM Penalties for submlltin <br />fate Informtedort <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />TYPED OR PRINTED g <br />. <br />Inciodint the poadblllty O one and Imprisonment for knowing violaUord OFFICER OR AUTHORIZED AGENT CODE NUMEIER YEAR MO DAY <br />COMMENTS AND EXPLANAI ION VI- ANT VIVIA I IVN5 frfNI/Inco a/f stracnmonrs nera) <br />ABLE SOLIDS LMT APPi IED FOR !=10YR, P HP PRF('TP F'.I-NT; <br />k. - a 1i Lj -i i f"sn:a: <br />EPA Form 3320-1 (Rev. 3199) Previous editions maybe used. *j$4 1-pa-( form PAGE OF