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PERM ITTEE NAME/ADDRESS pne" r.-; „ .`- ,• <br />NAME <br />ADDRESS aK MIr1FS <br />00A 53S <br />'1ERSET CO 81434 <br />FACILITY 0ORN C.RK & ELK CRK MINES <br />LOCATION 2P SET CO 81434 <br />r r cz T f ring A. PYFf' tl P <br />NATIONAL POLLUTANT DISCHAROE ELIMINATION SYSTEM (NPOES) Form Approved <br />DISCHARGE MONITORING REPORT (OMR) OMB No 204 4 <br />PERMIT NUMBER OISCHAAGE NUMBER ! - i' I q <br />!KFAC U. <br />r s <br />MONITORING PERIOD <br />YEAR 0 DAYd I YEAR MO DAY <br />FROM TO <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, <br /> <br />EX FREOUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT -., <br />C' 1 REQUIREMENT 1NST MAX rlpNT <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 />TITLE PRINCIPAL EXECUTIVE OFFICER ' fe^"y " nder r""y ° •" that this eocv meat and all .n.rnnrnu were <br />TELEPHONE <br />AM <br /> <br />DATE <br />prepared under my di-Ito. or mperelslow In accord.- with • system designed <br />N <br />E/ <br />?.. to sent r< Ih•1 qual f rd personnel properly gather and eeNuatr the Information <br />e"brnltled. Biased on my Inquiry of the person or persons who manage the system, <br />- T <br />l Ate f <br />f <br />tion <br />th <br />d <br />th <br />i <br />th <br />I <br />I <br />f <br />ti <br />. rnporn <br />or ga <br />, <br />or those persons di rec <br />er <br />ng <br />e <br />n <br />orma <br />e <br />n <br />orma <br />on <br />s"bmllted la. to the best of my knowledge and belle(. true, ,te+tr,le, and m-pWr, <br />SIGNATURE OF MUNCIPPAL EXECUTIVE <br /> I .m ,.are that Then are dgnffkanl penaltln for mbmllNng false Information, <br />TYPED OR PRINTED Including the podbmly or new and Imprltenment for knowing eIn411ons. OFFICER OR AUTHORIZED AGEWT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION Or AMT VIVLA I IUNS INerernnc• all •rracnmenrs neral <br />L_FAPLE SOL I OS LMIT APPI._ I ED, FOR -? p. 24NR PREC IF FVF'tVT; <br />EPA Form 3320-1 (Rev 3/99) Previous editions may be used Th1S IS a 4-paTi fOnTl. PAGE OF