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PERMITTEE NAME/ADDRESS (Ymh.& iaeYsgNaw?Lxwloa (JD(Qfwwnq <br />NAME <br />ADDRESS <br />J,, i _ <br />LG CO 81626 <br />FACILITY -"PER MINE <br />LOCATION I G CO 81621 <br />-MOND G. DU BOIS, PRES/GM <br />NATIONAL POLLUTANT OISCHARGE ELIMINATION SYSTEM NPOES) <br />DISCHARGE MONITORING REPORT (D R) <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 />MINOR <br />(SUDR ,1C) <br />F - FINAL <br />i2UNOFF /MINE WTR TO GF <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREOUENCY SAMPLE <br /> OF <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT EP OR T k##iz ## ####it It #ir ### 4 <br />1_ T= K t , <br />Y;.. ; rZL REQUIREMENT I D'IST MAX. <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> <br />REQUIREMENT r? <br />V <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMI T <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT ?- _ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> <br />PERMIT <br />REQUIREMENT <br /> <br />t "ruty under penalty o low that thl, document and ag attachments were TELEPHONE <br />NAME/TfTLE PRINCIPAL EXECUTIVE OFFICER <br />d <br />i <br />d <br />i <br />i <br />i <br />DATE <br />prepare <br />un <br />er my d <br />on or superv <br />s <br />rect <br />on In accordance with • system designed <br />' <br /> to awe- that qu&MrW personnel property gather and evaluate the Inbrmallon <br />submitted. Bawd on my inquiry of the person or persons who menage the systern. f <br /> or thaw persons directly mpotdble for gathering the Information, the Intermatlon <br /> submitted b.. to the best of my know ge and belief. true. accurate. and complete. <br /> 1 am aware that there are slgniflcaat pendHes For submitting fan Inrormaoon. SIGNATURE OF PRINCIPAL EXECLfffVE <br /> <br />YPED OR PRINTED ` <br />T <br />Inchnfint the possibility of fine and Imprisonment for knowing violatbnm <br />OFFICER OR AUTHORIZED AGENT AREAJ <br />CODE NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS fRdorenc• s/l attachments her*) <br />FAfil_.E '=rJL i r,cl (. T"i?'T ,APPI._TFrI FOR I.OVR: ?-INR °Rr ; I <br />EPA Form 3320-1 (Rev 3'49) Previous edit ons maybe used Thi,£js.,a_4-p ,(p rm. PAGE OF /?,