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PERMITTEE NAME/ADDRESS(7-i& ei rWry N-r.rLx.ti-(fD(QFaw,) <br />NAME <br />ADDRESS <br />0 60A 16 <br />Rr,IG CO 81 <br />FACILITY PER MINE <br />LOCATION I G CO 81 <br />,'MOND G. DU BOIS, PRES/GM <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDESi <br />DISCHARGE MONITORING REPORT (O 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 />[NOR <br />3UBR JC ) <br />- FINAL <br />NOTE: Read Irntrucdone 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 /> PERMIT ##dE#stit REPORT `; ! ?t >t ?F # 2 ?3F t I ., , <br /> REQUIREMENT f NST MAX - <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT '7 <br /> <br /> SAMPLE <br />l <br /> MEASUREMENT I <br /> PERMIT <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT (1 <br /> REQUIREMENT U <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />1 cerise . r penalty of law that lhh document ¦nd all attachmenb wrre <br />NAME/T7TLE PRINCIPAL EXECUTTVE OFFICER Prepared under my dlrxtt n or super iaton In accordance with a system designed TELEPHONE <br />DATE <br />?• ? to dare that qus"nfd Pen nmi Party rather and leduale the Information <br />-, <br />,I ,abmltted. Based on my inquiry of the person nr Per,ors who _ <br />the system ! <br />; <br />- ?' - or lhoae <br />w- directl <br />- <br />ordbk for <br />lh <br />tn <br />th <br />Infor <br />ati <br />th <br />r <br />I <br />f <br />It-- <br />i <br />y <br />P <br />ta <br />er <br />t <br />e <br />m <br />on, <br />e <br />n <br />onnau n t <br />it <br />a the best or my knewledte and belts <br />Submitted Is <br />accurate <br />and corn <br />kl <br />I-* <br />' <br />, <br />. <br />, <br />p <br />e. <br />. <br />1 am aware that them am 5191 Ce'"i Penalties for mbmltrint fahe Information <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />? <br />TYPED OR PRINTED , <br />Indudlrrt the podblery of nne.rd Imprf,onnrent for knowlnt .Id,lloret OFFICER OR AUTHORIZED AGENT A A NUMEIER <br />CODE YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference ofottochmonts here) <br />LE r,r, 'IDS APPL I FT-) 1'--DP l r`1'R . 74HR PRr"T P FVEI',I' <br />EPA Form 3320-1 (Rev 3199) Previous editions may be used. T;j)u j . g 4-? (. jO1Tp. PAGE ':