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PERMITTEE NAME/ADDRESS R-r f«Wry,vai.WLx.rlew (/D(brewq <br />NAME <br />ADORES S <br />BOX 463 <br />•JIA CO 8142 <br />FACILITY 1 E NO M I NE <br />LOCATION , I A O 8142 <br />_I_IAM DEAR .?, MINE MGR <br />NATIONAL POLLUTANT 04SCHARGE EUMINATION SY4TEm r/NPDE.W <br />DISCHARGE MONITORING REPORT (DMR/ <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 />NOTE: Read k?atructione before comploting thle form. <br /> <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREOUENCY SAMPLE <br /> OF <br /> EX ANALYSS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ..? } <br /> REQUIREMENT <br /> <br /> SAMPLE <br />x r,- MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />0, W I <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />.;e r.;??rt <br />-yet <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT s <br /> REQUIREMENT <br />rl?r i !_ t t: X <br />•IQNI f 1 <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT ... ;f <br /> REQUIREMENT <br />I SAMPLE <br />K Lr. I"f J d; P l MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT ?. as.;. <br />REQUIREMENT <br /> <br />..eye <br />NAMEMnE PRINCIPAL EXECUTIVE OFFICER t renlty ° ` pe"' p o bw Ihal Ihle dot°ment and all'luchments <br />TELEPHONE <br /> <br />DATE <br />prepared under my direction <br />apervlrtm In a rdenre .elth • system designed <br /> `nN <br />to emu" that queMfled person property 9alhtr and eeshett IM Infoematbn <br /> submitted. Board on my Inquiry of the person or persons who manage the system, <br /> or those P- directly MPorolbk foe gathering the Inrormatlon, be lnrormallon <br /> abmilled K to the bet of my kmwWgr end belief. trot. eavrale. and tompiete. <br /> 1 am aware that there am 11111lflt"m Peneltfe rot vubmlltlns hbe Inform.tton 5IONATURE OF PRINCNAL EXECUTIVE <br /> <br />TYPED OR PRINTED , <br />lneluding the Poadblilly of line and ImPRwnmenf for knowing rl"IsuorK <br />OFFICER OR AUTHORIZED AGENT ARE <br />CODEE NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference a# attachments here) <br />EPA Form 3320-1 (Rev 3f99) Previous editions may be used This is a 4-Part Bonn. PAGE OF