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PERMITTEE NAME/ADDRESS Qwrh.& Fw*y N.w?Lerriew (/Dt#Wwq) <br />NAME <br />ADDRESS <br />BOX i67 <br />I G CO 8162E <br />FACILITY ?PER MINE <br />LOCATION ?w CO 8162 <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM IINPDESI <br />DISCHARGE MONITORING REPORT IDMRJ <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 />(SUBR •JC ) <br />F - FINAL <br />DISCHARGE TO HORS <br />MOFAI <br />E GULCH <br />NOTE: Rssd Instructions bsf«til comp6ting this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, <br /> <br />EX FREQUENCY <br />of SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />- <br /> MEASUREMENT - ?_ <br /> PERMIT #at###ar #a # bj ###?c9t# ?. (.? ?,L1 Ii`1` <br /> REQUIREMENT MINIMUM AX I MUM <br /> SAMPLE r- r <br /> MEASUREMENT <br /> PERMIT ####at # # # #a4# u ar 3? 70 "ACE" <br /> REQUIREMENT ~ JO AV A Y MON T t- <br /> SAMPLE <br /> MEASUREMENT <br />E 1 (? PERMIT - ;s#afas ## # xa!#ar#%f OPTIONAL P, PORT NCE., "= <br /> REQUIREMENT 30DA AVG DP?ILY MX MONTI <br /> SAMPLE ti <br /> MEASUREMENT <br /> ' <br />' <br /> PERMIT #it + r. ac##i4li ?a „.; } :,Jv? u000 '?G?! t.t. <br />, <br />R; <br />v <br /> REQUIREMENT JQD V,:? DAIL Y MX MONT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT r.. y , ,, O UfVT I ;I','1( <br /> REQUIREMENT t,JST MAX GENT <br />i jl.lrli ; SAMPLE <br /> MEASUREMENT <br /> PERMIT REPO -?EPOR1 T (r, r+t <br />c7 , , ?. REQUIREMENT OODA, I LY MX <br /> SAMPLE <br /> <br /> MEASUREMENT <br />- <br />R <br />PERMIT as Iritil 7-7 . ## r it?Ei! n REPORT <br />REQUIREMENT JODA AV' .311 MX r' <br />ME/T1TLE PRINCIPAL EXECUTIVE OFFICER a nruly under pen, Ir o a. that thh docoment and all artochments were TELEPHONE DATE <br />NA <br />prepared under rear direction or superelslon in accordance with • enlem deaigried <br />to assure that qu,flrled personnel propnly galtwr and e•aluate the inrormallon <br />submitted. Based on my Inquiry of the Person or person who mange the system ,?- <br />or those persons directly responsible for gathering the Information, the Information <br />submilled b, to tht beat (-y knowledge and belkf. Ine. accvnle. and complete. <br />IGNATURE OF PRINCIPAL EXECUTIVE <br />t I am aware that there are signirkant Penalties for submitting robe Informadon, S A WA <br />.i <br />TYPED OR PRINTED Including the poaaibiliy of Ilne and Imprisonment roc knowing violauom OFFICER OR AUTHORIZED AGENT C <br />E NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIVLAT IONS IRSfsrance sea afracnrrianfs nora) <br />L1 SOLIDS LIMIT APPLIED FOR <'=10YR. 24HR PP.F'CTP EVENT- <br />. <br />77}?},?11 s;3 rm. PAGE OF <br />EPA Form 3320-1 (Rev 3'99) Previous editions may be used C;T v - ?- L+?4