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PERMITTEE NAME/ADDRESS(7m"FatiMryNandL eti-l/DW6waj <br />NAME <br />ADDRESS [RAPPER ! iN-E <br />0 BOX 18 <br />,:,TG CO 81626 <br />FACILITY "PER MINE <br />LOCATION I G O 81625 <br />MOND G. DU BOIS, PRES/GM <br />NATIONAL POLLUTANT OISCHAr10E ELIMINATION SYSTEM NPDESI <br />DISCHARGE MONITORONO REPORT /D R! <br />PERMIT NUMBER DISCHAROE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved <br />OM8 rho 2040-0004 <br />MI <br />F - FINAL MOFAI <br />POND #3 TO MIDDLE PYEATT GULCH <br />NOTE: Read Irrtnictlorr before l h.letlRA this fnrm. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ, FREOUENCY SAMPLE <br /> OF <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE <br /> SAMPLE <br /> MEASUREMENT <br />r PERMIT REPORT :>f##?ti' ?E## i?#iiii#it II1C , <br />!. REQUIREMENT INST MAX <br /> MOf1 : r <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />I <br /> SAMPLE _ <br /> MEASUREMENT <br /> PERMIT llj <br /> REQUIREMENT <br />I. <br /> SAMPLE l <br /> MEASUREMENT t` <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 />NAMEnME PRINCIPAL EXECUTNE OFFICER I ct ,ly " e penalty I'- that this document and all lt_hmenu were <br />prepared under my direction or supeeebiom In accordance with a syslem designed TELEPHONE DATE <br /> to assure, that quallnod personnel property gather and evaluate the information <br /> sabmlited. Based on my Inquiry of the presets or persons who manage the system. <br />- or those persme directly responsible for gathering the Information, the Information <br /> submilled b, to the bast of my knowledge and belief. Ime, occnrstr, and complete. r <br /> I am aware that them on signifkant penattie for submllting rain Inl6nnatlom, SIGNATURE OF PRINCIPAL EXECUTIVE <br />TYPED OR PRINTED Incfi,ding the posiblety of Bne and Imprisonment for knowing violations. OFFICER OR AUTHORIZED AGENT <br />AREA <br />ODE NUMElER <br />C <br /> <br />YEAR <br /> <br />MO <br />] <br /> <br />DAY <br />vvrermcn..a rh.ev ?... ...-..... ...... ?. ._.-. _._?.-.. ?.... ..... weer.... w.. ......... rr.r.v r.wr wr <br />=ABLE SOLIDS LIMIT APPLIED FOR <=I0YR,24HR PRECIP EVENT- <br />DS MONITORING - I . B . 2. <br />EPA Form 3320-1 (Rev 3199) Previous editions may be used. '200 /1 TT-W»is a:a-part;form,