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PERMITTEE NAME/ADDRESS(Ine" ryNawe?LeraNer l/DIQGrrruJ <br />NAME <br />ADDRESS <br />LUX 4b s <br />AIA CO 81428 <br />FACILITY I -E NO. 2 MINE <br />LOCATION '4 I A CO 81428 <br />_LIAM A. BEAR JR. MINE MGR <br />NATIONAL POLLUTANT OISCHAROE ELIMINATION SYSTEM (/WDES) <br />DISCHARGE MONITORING REPORT IDMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DA YEAR O D Y <br />FROM TO <br />Form Approved. <br />OMB No. 2040-0004 <br />(SURF, <br />F - F I SNAL SR/MINE WTR TO DEER TRAIL DTCH <br />NOTE: Read "truetlons before completing this fofm. <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 <br />I T <br />T <br /> REQUIREMENT Iti -)T MA X <br /> <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 />MTLE PRINCIPAL EXECUTIVE OFFICER t rernry u r gene Ivy o law in?T mh eocument cne a6 anernmecrts were PHONE DATE <br />NAME <br />prepared under my dfrertlon a wper.t>fan In eccordanm with • system destjned <br />Io more that quollned personnel property [ether and e•eluele the Information <br />ebmllted. Bead on my Inquiry or the persat a Permit who manage the system. <br />L: <br />w thole penmrt directly rnportlbk for gathering the Info tion. The Information - <br />th <br />b <br />r m <br />kr <br />wl <br />r <br />I <br />t <br />t <br />d <br />d b <br />B <br />d <br />kt I <br />1 <br />y <br />Ar <br />e <br />ge an <br />rue, accura <br />wbmttted Is. to <br />e <br />es <br />o <br />e <br />e <br />. <br />e. an <br />mmp <br />e. <br />SIGNATURE OF I RINCWAL EXECUTIVE - <br /> I am aware that then: ere elgntftrant penalties for ebmltting retw Information. <br />TYPED OR PRI NTED Inctuding The peadblUry or Ilse and Imprisonment for knowing rfotauorss OFFICER OR AUTHORIZED AGENT NU <br />M[iER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference ON attachments hors/ <br />AP PPECIP EVENT IS CLAIMED. IF CLAIM APPP.OVED BY WGCD, <br />------------------ <br />EPA Form 3320-1 (Rev 31") Previous editions may be used. This is a 4-part form. PAGE OF