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PERMITTEE NAME)ADDRESS(lm"Faclbty No.?Lxarro.I(DtO6nw.) <br />NAME <br />ADDRESS <br />130A 187 <br />1-IG CO 81 <br />FACILITY ,PPER MINE <br />LOCATION - • I G co 81 <br />..vivimmn (. nil RnTc;. PRFSf(:M <br />NATIONAL POLLUTANT OISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT WMR) <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 />ACUTE WET TF <br />NOTE: Read Ir+structiorn bsl(xs compistirtp this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. <br /> <br />EX FREOu"cY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT xj` C GF? <br /> REQUIREMENT VALI i_ <br />rMN <br /> SAMPLE <br /> MEASUREMENT <br />1. PERMIT , <br /> REQUIREMENT 'i`1Pi VAt_.Jc <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT j <br />i <br /> SAMPLE \ r <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT No <br />J <br /> SAMPLE i <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIREME <br />T <br /> N <br />NAMEfnnE PRINCIPAL EXECUTIVE OFFICER 1 nrirty under pen, q . law that th <br />prepared under my dlrectlon or sup is documrnl and ail attachmana were <br />enlSlon In bccordoner with it system designed TELEPHONE DATE <br /> <br />' - to oaure that qualified perwnnel property gather and eyafuatr the Infnrwrllon <br />submitted. Shed on m Inquiry or the on or <br />7 per eon who manage the system. . <br />. ? : . -. <br />d <br />l <br />ib <br />f - <br /> or (hole peraem <br />irect <br />y respons <br />or gathering the Information, the Information <br />le <br /> mbmllted Is, to the belt of my Yn te, and better, true, accufale. and complete. <br />' i <br />nifi <br />I <br />th <br />t th <br />t <br />f SIONATURE OF PRINCWAL EXECUTIVE <br /> en are S <br />g <br />can <br />am aware <br />a <br />penattlef for submitting false In <br />ormation, A AEA <br />TYPED OR PRINTED including the possibility of fine and Imprisonment for knowing y(otadotn OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />UUMMtN 1 J ANU tA?YLANA t Ivn yr nr. r . rvs.rs r rv.w rnwrwr w-ai, wr .r.ws.nrnwcrw .. wr wr <br />r RSPORT LCSO - STATISTICAL POINT ESTIMATE WHICH IS <br />ncn rti n? <br />TW_jj ,a.3-pall IOrrn. VALE OF / <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used