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PERMITTEE NAWJADDRESS (7-h-& FawryNo.?Lsrortew I/D(Qlwanr) <br />NAME <br />ADDRESS .. <br />BOX S35 <br />=RSET CO 13143 <br />FACILITY ";ORN CRK & ELY. CRM MINES <br />LOCATION _RSET CO 5143 <br />i-IES T. COOPER, EXEC V. P. <br />NATIONAL POLLUTANT OISCHAROE ELIMINATION SYSTEM NPDES/ <br />DISCHARGE MONITORING REPORT (O R) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved <br />OMB No 2040-0004 <br />MINOR <br />(SUBR MH) <br />F - FINAL G{. V S <br />SEDIMENT POND TO SANBORN CREEK <br />NOTE: Road Instructions before completing 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 /> MEASUREMENT <br /> PERMIT ### a REPORT )NCE/ <br /> REQUIREMENT ; NST MAX MQNTF <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <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 />NAMEfnTLE PRINCIPAL EXECUTIVE OFFICER I ren'ty under Pena p 0 (law that thH document and all altachments were TELEPHONE <br />l <br />A DATE <br />prepared under my dirert <br />nn or super + <br />- In accordance with ¦ fysteen deal[ned <br />to cart that qualified Personnel praptrty Lather and evaluate the Information _ <br />submltted. Bred Cm my Inquiry of the Peron or perfume who manage the system, . <br />or those persons directly mponslbk for galheArcg the Infortrutloet <br />the lnrormatbn ()?i G? ? r t <br />. <br />to the beat of my knowledge and beilef <br />/ submitted Is <br />Irve <br />accurate <br />and <br />l <br />t <br />/ <br />• <br />. <br />mmp <br />e. <br />. <br />, <br />e <br />- I am aware that there art significant penalties for wtbmltfin <br />? <br />robe Informae <br />SIGNATURE OF PRINCWAL EXECUTIVE <br />n <br /> g <br />o <br />• AREA <br />TYPED OR PRINTED In h ding the poaalblBty of fine and ImpAaonmrnt for knowing rlolatlom OFFICER OR AUTHORIZED AGENT ODE NUMBER <br />C YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIULA IIUNS (Reforence an arfecnmenrs nora) <br />501 ?D- r^T ,F'r' I tr> FCIR r) VP 7111-1'(7 Cfn ? 7r ^•!T: <br />it 11 etiv f <br />This is a 4- an form. PAGE OF <br />EPA Form 3320-1 (Rev. 3/99) Previous editions maybe used P .