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PERMITTEE NAME)AODRESS(7..6 jrr k#,N.rrLerrraw(/D(f--) <br />NAME <br />ADDRESS - J. 13OX 535 <br />-.t1ERSET CG 81 <br />LOCGATIO0N ;njBORN CRK & ELK CRK MINES <br />T1 r+IERSET co 81 <br />AMES T. COOPER, EXEC V. P. <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM //NPDES) <br />DISCHARGE MONITORING REPORT IDMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO I I i <br />Form Approved. <br />OMB No. 2040-0004 <br />MINOR <br />(SUER MH <br />F - FINAL GUTAI: <br />SEDIMENT POND TO ELK CREEK <br />NOTE: Read k»tructione before completing thle form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FAEOUENCY SAMPLE <br /> OF <br /> EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ####?rr ## 6. `-; rat# 1 L) <br /> REQUIREMENT <br />r <br />' <br />` <br />T <br /> 1 <br />LL <br />; I;O <br />d <br /> SAMPLE , ?.. <br /> MEASUREMENT <br /> PERMIT ;fit#it 3i ##ita z: #v7i3t ri :',5 70 i•i"::E! <br /> REQUIREMENT <br /> aQE-A V" r. ii iY ;??lf;T <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ###st## ##### ',f#tE#if REPOR I F,LFORT <br /> REQUIREMENT 30DA AW DAILY FIX <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT #'t## #it#### #3F#### 3000 h000 INCE R. A-1_; <br /> REQUIREMENT -?.)DA AVt; DAILY MX ?1()NTi• <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT .fit l^ fi-:: axe 10 ONTlI _3 <br /> REQUIREMENT Ar1,4SI' M(tX '•;T t <br /> SAMPLE <br />IVI N_ MEASUREMENT <br />_ 0 PERMIT REPORT REPORT S#if# r ... ?NCE/ If;STr f <br />`NT REQUIREMENT :;QL)A i ? i. LY MX MONTH <br />r rj',-- - SAMPLE .. <br />-;, - MEASUREMENT <br />- <br /> PERMIT ?'I**## ;**** - REPORT REPORT ?- ,I= <br /> REQUIREMENT ==RTR : /\ I L.Y MX <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER l tenuy under peoa y o law that this document and atl attachments were <br />TELEPHONE <br />DATE <br /> prepared under my direetbn or super.tslon in accordance with . system designed <br />- to assure that quattned personnel property rather and evaluate the Information _ <br /> submitted. Owed on my Ingwwlry or the person w persons who manage the system, _+- <br /> or those persons directly responsible for tothertntt the Info Hon, the Information <br />- submitted Lit, to the best or my knowledge and better. true, accurate, and compkie <br />I am aware that there are signnincant ismaitiv for submittin <br />fate Information <br />?EIGNATVRE OF ?RINCIPAI EXECUTIVE <br /> g <br />, <br />I <br />d <br />di <br />th <br />ibilit <br />f fi <br />d <br />i ARtA <br />TYPED OR PRINTED n <br />u <br />ng <br />e poss <br />y o <br />ne an <br />Impr <br />sonment for knowing AoIstiorm OFFICER OR AUTHORIZED AGENT <br />ODE NUMBER <br />C <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS /Reference sN attachments here) <br />F Rf 15 7' M-r ! = ?' . G T• F OR r, r, •- , <br /> <br /> <br />EPA Form 3320-1 (Rev- 3/99) Previous editions may be used This is a 4 -Part form PAGE OF