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PERMITTEE NAMEIADDFtESSpmh,&forOyNa wL«ononyDo6,ew/ <br />NAME <br />ADDRESS <br />-. iiUX 16' <br />AIG CO 8166 <br />FACILITY - i,MPER MINE <br />LOCATION ajIG CO 81625 <br />AYMOND G- DU DOIS, PRES/GM <br />NATIONAL POLLUTANT OISCHAROE ELIMINATION SYSTEM //NPDESI <br />DISCHARGE MONITORING REPORT fDMR/ <br />PERMIT NUMBER DISCHAAOE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved <br />OMB No 20404)004 <br />MINOR <br />(SUBR JC ) <br />F - FINAL <br />AISCHARGE TO SAGE CREED <br />NOTE: Read Instructiom before completing We form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> <br />EX OF <br /> ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT 6. S ti- 9. O '=Pu,L I{'!5I <br />I REQUIREMENT z -` :• M I pt UM MAXIMUM <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT i #;r # # el ## - Yt 1}* k i ;- OP _V! DIAL S ,NCE / 'BRAD <br />1C;. REQUIREMENT s<xi--- <br />r AVG <br />4&e' DAILY MX MDI`iTt <br /> SAMPLE y <br /> MEASUREMENT <br /> PERMIT riit#it?it :iF#iF#iFi! t: 1 I # #ft? #iF###?t 110 <br />..i:_ <br /> REQUIREMENT 1 "" J INS T MAX (ENT <br /> SAMPLE <br /> MEASUREMENT <br />- PERMIT REPORT # <# 1F##;f #####,? vc _ NSTAt, <br /> REQUIREMENT --ODA L MX <br /> SAMPLE <br /> MEASUREMENT <br />t?'S 1 Q Q PERMIT I; :: s F r-r s13:- #3t ,- : R?-PL'R . J L :N: , <br />'ENT C:! REQUIREMENT +0L>A DATL'Y i"fX <br /> SAMPLE <br /> MEASUREMENT <br />l PERMIT <br /> REQUIREMENT 'JST M::•? <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br /> <br />thh document and all ewCh mere TELEPHONE <br />NAMERTTLE PRINCIPAL EXECUTIVE OFFICER ' remit under Pena o tan that <br />DATE <br />prepared under ray direction or wpenfston In accordance with . • system darned <br />to assure that qualified personnel property gather and evaluate the Inhnmratlon <br />i <br />ir <br />of th <br />x <br />- <br />b <br />it <br />d <br />B <br />d <br />th <br />m <br />nqu <br />y <br />e person or persons who manage <br />su <br />te <br />. <br />ase <br />on my <br />e systen, <br />- - or than Persons dimetty rsspom!W for gathering the Information <br />the Information <br />, <br />_ submitted ls, to the best of my knowledge and belief, trot, accurate, and compklt. '. <br />I am aware that there are significant Penalties for subnliting false Information <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />TYPED OR PRINTED , <br />Including the possabiilty of fine and Imprisonment For knowing Aoistlons. OFFICER OR AUTHORIZED AGENT CAHEA ODE HUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference eM attachments here) <br />?;131.F ''=Q!_ IDS LIMI T' APPL IFn FOR '=i OYR, 4Hr- OF? <br />ING - - t."t r is <br />This i5 a 4-part font. PAGE OF / <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. -