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PERMITTEE NAME)ADDRESS (1nei.4 faeibfy Nwa?l.eearraw (/D(Oirwn) <br />NAME <br />ADDRESS <br />pox ia7 <br />IG CO 8162 <br />FACILITY -`PER MINE <br />LOCATION I G CO 8162 <br />- n.-..t, none rote <br />NATIONDI CHARGE MON TO IR NO REPORT (DMRI?ESI <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />MINOR <br />(SUBR JC ) <br />F - FINAL MOFAI <br />POND #3 TO MIDDLE PYEATT GULCH <br />NOTE: Read Inatrucdonr beforA'complet{ng this tarn. <br /> - <br /> <br />QUANTITY OR LOADING <br />QUALITY OR CONCENTRATION <br />NO. DUFNCV <br />FREO SAMPLE <br />PARAMETER EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> 7 - - <br />- <br />, , 1 r75 I k. <br /> PERMIT 7 7 <br />7- 6 <br />M <br />• MAX IMUM <br />Gf r, . REQUIREMENT M, I f <br />.! I MU <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT r <br />A A t <br />DAt <br />L' M >' X "IOI'3 T( <br /> REQUIREMENT , <br />- u . - <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> <br />-ODA AVID ? <br />Uf 1L <br />Y MX <br />MONTH <br />_ REQUIREMENT .. <br /> <br />?. SAMPLE <br />MEASUREMENT <br />I I <br /> <br />_ = <br /> PERMIT r - <br />-=A DAILY MX - MONTH <br /> REQUIREMENT , <br /> SAMPLE <br /> MEASUREMENT <br /> sr 3y _ Is t I •' <br /> PERMIT INS T MAX <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br />' <br />DAILY M <br />"?- i: <br />- <br /> REQUIREMENT C1GA r, . , <br /> SAMPLE <br /> MEASUREMENT <br /> <br />PERMIT y C DA AV(3 DAILY MX <br />REQUIREMENT _ <br />NAMErnnE PRINCIPAL EXECUTIVE OFFICER I "nny ° tr pin. q ° Iaw thee this °°c°mrm end see ut.rhments were TELEPHONE <br />prepared under my direction or supervision in accordance with a system designed DATE <br />to assure that qu*Hfkd personnel properly gather and eeaht.te the Inrormallon <br />- submitted. Based on my Inquiry of the pnsat or persona who manegt the syttrim <br />. or those persons directly responsible for gathering the Inform.tion. the Information <br />submNted Is. to the bet of my knowledge and belief, true. smcurste• and compleft. <br />T <br />E <br /> I am swam that there are significant penalties for submitting ratio inrorntstlon. IV <br />SIGNATURE OF ?RINCMAL EXECU <br />OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br />TYPED OR PRINTED Including the possibility of few and hnyrbenmeni nor knowing etol.tiorm CAE <br />n0 Ingrtrrffnc- - w..w...... I <br />COMMENTS AND EXPLANATION <br />ABLE SOLIDS LIMIT APPLIED FOR - 1O'Yl?r 24HR PR-!-_, !_ . <br />DS MONITORING - I . B . 2. <br />-- ri11S t$-P3Il lOftll vvlvt yr <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used.