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PERMITTEE NAMUADORESS (1-rb*larfkryMmw?Lorrt°w 1/D(Obnw) <br />NAME <br />ADDRESS <br />BOX 187 <br />I (; CO 8162E <br />FACILITY . ¢PER MINE <br />LOCATION I G co 8162'! <br />. .... s•r+ nnrr. OUT <br />NATIONAL POLLUTANT DISCHARGE EUMINATION SYSTEM /INPOESI <br />DISCHARGE MONITORING REPORT /D MR! <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO 1 -1 <br />Form Approved <br />OMB No, 2040-0004 <br />MINOR <br />(SUBR JC) <br />1= - FINAL MOFAI <br />P )NOFF/MTNE WTP TO OAK GULCH <br />NOTE: Read kwBtructitxw be1«.lro pfitlnp thleform. <br /> NO FREOUENCY SAMPLE <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION . OF <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT # ### ##### 5 ##it #if 9 CI !._ I N9I T <br /> REQUIREMENT iM NI P Ull MAXIMUM <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT ### +t V. 'A :-!i"E/ GRAB <br /> REQUIREMENT JA I L Y 11X MDN 7i <br /> SAMPLE <br /> MEASUREMENT <br /> RAB <br /> PERMIT x = :.. t:W ? I ONAL REPORT Iv : / G <br /> REQUIREMENT IA <br />A4G . <br />DAILY M5 i'If lt. 7 <br />i <br /> SAMPLE <br /> MEASUREMENT <br /> l ;, n <br /> PERMIT s:" ::? ,i ;s vl uv..."D <br /> REQUIREMENT F,`•J: DAILY J*lX MONTH <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br />L, T MAX <br />;T <br /> - <br />I SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT PD f Y <br />= <br />; REPORT <br />I LY M X <br />' I J`. t r` <br /> , , <br />'A r I_ f <br />I <br /> SAMPLE <br /> MEASUREMENT <br />- <br /> <br />REPORT REPORT <br />PERMIT <br />REQUIREMENT :SODA AVG DAILY MX <br />NAMEmnE PRINCIPAL EXECUTIVE OFFICER I certtry under penalty ° law that thb document ¦nd all altwhments were TELEPHONE <br />prepared under ml dlnctlon or fupe. on In accordance with a system destigned / DATE <br />to assure that qualified personnel Property Lather and evaluate the Information submitted. Based on m7 Inquiry *(the person or Persons who mrnap the sptem. XI/11- <br /> <br />those persurr dlrectlT rnponslble for gathering the Information, the Information <br />or <br />i <br />submitted Is. to the be!t or my inowfedge and beW, true, accurate. and compiefe. <br />TURE OF PRINCWAL EXECUTIVE <br />I <br />N <br />( . <br />.l, F. ' • . . I am aware L%al then are alp ific"t Penalties for wrbmNnnE lobe Informockm. S <br />G <br />A E NUMBER <br />C <br />YEAR <br />MO <br />DAY <br />TYPED OR PRINTED ' <br />InAudfn6 the poaefbl4tT of line and Imprtaortment for knowing ridatlgti <br />OFFICER OR AUTHORIZED AGENT <br />OD <br />COMMENTS AND EXPLANA I sun yr nn, vlvLn i rvni, lrrstwrwnew on wer.a .rre..r.. e <br />i-,Rl_ F SOLIDS LIMIT APPLIED FOR - I OYR, 24HR PREC I P EVENT- <br />'10NITORIN'. l _r I r, <br />• This is•a 4-part erm. PAGE OF <br />EPA Form 3320.1 (Rev. 3199) Previous editions may be used.