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PERMITTEE NAME/ADDRESS (f.aMfr F.,Aty Nm.arL.crtrt ((D(fa t) <br />NAME <br />ADDRESS <br />i. BOX 535 <br />_!. ?IERSET CO 8143 <br />FACILITY ;'JBORN CRK & ELK CRK MINES <br />LOG'S IERSET CO 8143 <br />:?,P4FS T rnnPFf3. FYFr V P <br />NATIONAL POLLUTANT DISCHAROE ELIMINATION SYSTEM IINPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER OISCHMOE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TTO <br />Form Approved. <br />OMB No 20404004 <br />MINOR <br />(SUBP MN ) <br />F - FINAL <br />SURF RUNOFF TO N FK GUNIS I <br />NOTE: Read Ir»trucdone before completing this form. <br />.; s <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREOUENCY SAMPLE <br /> > <br />EX OF <br /> [ <br />< ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT =. ## a Ii #it### 5. =, ## iF# tt- 9.0 <br /> REQUIREMENT Mir-4111UN MAXIMUM <br /> SAMPLE <br /> MEASUREMENT <br />_ PERMIT ### #, ?fi #?t•?c#!? 3S 70 <br /> REQUIREMENT <br />ti Ti <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ###tt## tI###st# IE####iE REPORT REPORT I?JCE/ ^Rr= <br /> REQUIREMENT 30 A DAILY MX MONTH <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ####3r't ###### ###### 350f.1 'JOgQ 7INCE/ <br /> REQUIREMENT 30DA AV'0' DAILY MX ATH <br /> SAMPLE <br /> MEASUREMENT <br />1 C) PERMIT - x,. -.? ?C ti tr#? ##iI;s s :•..-t " t. C3iVTI? iu; i?!3 <br /> REQUIREMENT <br />` <br />QI`' SAMPLE <br /> MEASUREMENT <br />1 PERMIT REPORT REPORT x# ### # INSTA <br /> REQUIREMENT ,.i(?DFI r. 1I LY ' ?: <br />TOTAi SAMPLE <br /> MEASUREMENT <br />PERMIT ###x ; >. K ttlE?t#s :. REPORT P R i „i_Y A <br />REQUIREMENT _A)DA AW DAILY MXX <br />1 reruly Y neler pens iy O law that thh G-men( and .II attachments were <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER <br />TELEPHONE <br />DATE <br />prepared under my direction or superNslon to accordance with ¦ system designed <br />- to a rs that qualified personnel property gather and evaluate the Information - <br />- <br />- <br />sabmltted. Bred on my Inquiry of tIw person or persons who manage the system, _ <br />th <br />di <br />tl <br />re <br />lbl <br />f <br />t <br />c <br />or <br />ou penom <br />y <br />spons <br />rec <br />e <br />or ga <br />hering the Information, the Information <br />• . _ <br />b - _ <br />ur <br />mltled Is, to the bet of my knowledge and bdW, Inre, ac mle. and compMt. <br />r I am aware that them are significant penalties for wrbmlttin <br />rape Informatlon <br />SIGNATURE OF PRINCWAL EXECUTIVE <br />- g <br />, <br />I <br />i <br /> <br /> <br />PRNdTED <br />TYPED <br />OR <br />1 <br /> <br />ntrud <br />ng the possibility of fine and Imprisonment for knowing H.istlons. <br />1 <br /> <br />OFFICER OR AUTHORIZED AGENT <br /> <br />CODE NUMBER <br /> <br />YEAR <br /> <br />MO <br /> <br />DAY <br />COMMENTS AND EXPLANATION UP' nnT VIULA I Wnlb wererence off erracnmenrs natal <br />F- AT. I F Pr1 IDS I-MT APP!_I=r; rnq - ^,YR `4Nra <br />r *P <br />MT <br />-t,'rP,IY; <br /> <br />- -- - - I il1!•F 1 l L is r.. <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. This is a 4-Pair Corm. PAGE Of