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PEF1MrME NAME/ADDRESS (/wrbbi e&#yjv..wL.e.rl..I/Dow d) <br />NAME <br />ADDRESS - <br />OUX Ib/ <br />rIG CO 81626 <br />FACILITY IPER MINE <br />LOCATION ! G CO 8162ti <br />:`MOND G, DU BOIS, PRFF;/rM <br />Form Approved <br />NATIONAL POLLUTANT OISCHAIIQE ELIMINATION SYSTEM NPOESI OMB No. 2040.0004 <br />DISCHARGE MONITORING REPORT /D R/ <br />PERMIT NUMBER k-S.-GE NUMBER - FINAL <br />MONITORING PERIOD P:?T TESTING FOR 021A <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> OF <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX <br />ANALYSIS <br />TYPE <br /> SAMPLE <br />MEASUREMENT <br /> <br /> PERMIT ## # ###? 100.0001 <br />}##?t# <br />## <br />?_ <br />?LY <br />F?A3 <br /> REQUIREMENT MN VAL' " <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT #sf##tr #3;# ## 10 . 1 u:,. iF# fi#'#### iTRLY ;RAI <br /> REQUIREMENT MN VALUE <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 /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I aria, . er pen. ty .71- that thh document and an atl Khments were <br />TELEPHONE <br /> R ered under m dlr flon or su <br />p P 7 per.fllm in ae<ord.nee with . system designed DATE <br /> to mare that qu.Nned Personnel Property gather and evaluate the inrnrrnailon <br /> submitted. Bred on m7 Inquiry of the per or person who manage the system. <br />th <br />dl <br />tl <br />ible r <br /> <br />/ or <br />ose person <br />m <br />7 respons <br />er gathrAng the Infoematlon, the InfornrUon <br />_ <br />- <br />1 ... ' • e Submitted b. to the best of my knowledge and beer(. Irve, .rrunte, and complete. i.. ,. / <br /> I am aw.re that there are flgNnunt Penalties for submitting robe Intbe-e ten. SIGNATURE OF PRINCIPAL EXECUTIVE <br />TYPED OR PRINTED InHudingtheposalbluryorfine .nd lmpA,onmemrorknowing rtd,tlam OFFICER OR AUTHORIZED AGENT NUMBER YEAR MO OAY <br /> CODE <br />PP 6.8, FOR DETAILS LIF PF. 'E. REPORT LC50 - STATISTICAL POINT ESTIMATE WHICH IS <br />OF TEST ORGANISMS, I-Ai E TOXICITY TEST REPORT FORM TO DMR. WHEN WET TESTING NOT <br />EPA Form 3320-1 (Rev 3199) Previous editions may be used <br />1660/