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PERM(TTEE NAME/ADDRESS pncr& i.r+hryN.+.rL«rta Uo?CEIVED NAn?DISCPLUTT HARGE MON TO RINIMINATION G REPORT (DMRIPDESI <br />NAME <br />ADDRESS - <br />BOX 48-- MAY 0 a 2Q09 PERMIT NUMBER DISCNARGENUh1eER <br />t•J I A <br />FACILITY I E NO, 2 N. i Division of Reclamation, MONITORING PERIOD <br />LOCATION `•J I A Mining and. Safety FROM YEAR MO DAY TO YEAR MO DAY <br />!._LIAM A. BF, <br />Form Approved. <br />OMB No. 2040-0004 <br />MINOR <br />(SUBR MH) <br />F - FINAL DELTA <br />SR/MINE WTR TO DEER TRAIL DTCH <br />NOTE: Road Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT # ;tit#iI z S O ' i L S Tl <br /> REQUIREMENT M I N I MUM MAX IMUM <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT A# # a ., r #38##it _ i J 1 y` r , <br /> REQUIREMENT 30DA AVG DA I L R. (10i'41T;-i <br /> SAMPLE <br /> MEASUREMENT <br />S 7 0 PERMIT x 3F 1 . ,1, <br /> REQUIREMENT 30 GA A%'t3 DAILY MX MUNZ H <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />r' <br />w <br />, t( <br />- i <br /> REQUIREMENT 30DA AVG DAILY MX MONTH <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT L .,, ; _• <br /> REQUIREMENT MST MAX i,ENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT = - <br /> REQUIREMENT CDA AVCS DAILY MX <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT ; . <br />REQUIREMENT )RTR <TR MAX <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER ' «"' ' under penalty ° taw that this document and all stiKhments were TELEPHONE DATE <br />prepared under mr direction or superrlelon In accordance with a system ddgned <br />to enure that quallned personnel property gather and evaluate the Information <br />submitted. Bred on my inquiry of the person or persons who tnsnage the system <br />l <br />i <br />y respons <br />ble for gathering the Inforwulion, the Information <br />or those persons dirti <br />f <br />4 -- <br />..' - .- -- <br />my ?now <br />dge and belief, tree. Kcvnte, and complete. - <br />submilted Is, to the bet o <br />IGNATURE OF ?RINCI?AL EXECUTIVE <br /> I am .wart that there an slgnincant penalties for wbmltting false Information, S <br />TYPED OR PRINTED Including the possibility of flee and Imprisonment for knowing violations. OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference aN attachments hers! <br />LiF7 °RECIf' EVENT IS CL_A7MED. IF Cl__AIM APPROVED BY WC3CD, <br />it JC . . <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used TWs is a 4-part form. PAGE OF