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PERMITTEE NAME/ADDRESS(lwdrir Frtbty NwdL«araom l/D(6ewsr) <br />NAME <br />ADDRESS <br />BUX 187 <br />..IG CO 8162 <br />FACILITY ,'PER MINE <br />LOCATION !G CO 81 62 <br />YMOND G. DU BOIS, PRES/GM <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDESJ <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER k;-C-MGE NUMBER <br />MONITORING PERIOD <br />YEAR MID DAY YEAR MO DAY <br />FROM TO <br />Form Approved. <br />OMB No 2040-0004 <br />MINOR <br />(SUBR JC) <br />F - FINAL <br />BISCHRG TO FLUME GUI <br />NOTE: Read Instructions before "Completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. <br /> <br />EX FREOUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />:. SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REPORT <br /> REQUIREMENT T MAr. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT r <br /> REQUIREMENT t I <br /> SAMPLE j' <br /> MEASUREMENT <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 />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER ' """' " er "a nrT. ma thlr document and au ItwhnwnLs were <br />TELEPHONE <br />DATE <br />prepared under my direction or supervhlm In accord me will, a system designed <br />- to Aware that qualified personnel property gat1wr end evaluate the Information <br />' . - wrbmltled. Based on my Inquiry of the person or person who manage the system. <br />' or those persas directly respoenible for gathering the Information. the Informaton r-- <br />to the bell of my know4dge and belief <br />submitted b <br />brae <br />accurate <br />and com <br />hte <br />, <br />, <br />, <br />, <br />p <br />. <br />t <br />INGNATURE OF PRINCIPAL EXECUTIVE <br />fi <br />l <br /> can <br />pena <br />I am aware that them are 00 <br />ties for asbml/ung bbe Infenrulion. AREA <br /> <br />TYPED OR PRINTED <br />InAudInit the pasdbauty of line and ImpMonment for knowang vloaatfom <br />OFFICER OR AUTHORIZED AGENT NUMBER R <br />CODE <br />YEAR <br />MO <br />OAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS /Refirrsnce ad/ sttschments hers/ <br />D! r .QL_? ! TijT't P.°PL T rD FOR 1C)YR, 24HR PRECIP L'JcNT- <br />EPA Form 3320-1 (Rev. 3/49) Previous editions may be used. T}US IS 8 4-p4n,!?r 1. PAGE OF