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PERMITTEE NAMEIADDRESS p.dd. F-r*IYNrr?Locartan VD(Qm-) <br />NAME <br />ADDRESS <br />BOX I8/ <br />G CO 81 <br />FACILITY PER MINE <br />LOCATION : G CO a] <br />:rAnwtr% n nl t DrITC 001=1; /[^_h <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPOESI <br />DISCHARGE MONITORING REPORT IDMRI <br />PERMIT NUMBER DiSCHARDE 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 />(SULR JC) <br />F - FINAL M <br />POND !#5 TO NO NAME GULCH <br />NOTE: Reed Inetructlone before completing this form. <br /> <br /> <br />METER <br />PARA QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, 7 SAMPLE <br /> <br />EX 11A <br />TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />MEASUREMENT <br />L(` <br />ll <br /> - r_? , • I - <br /> PERMIT :. ,. <br /> REQUIREMENT M I N I r1UM MAXIMUM <br /> SAMPLE i-- <br /> MEASUREMENT <br /> L r• <br /> PERMIT t _ <br /> REQUIREMENT 30DA F1 %c? DAILY MX MONTH <br /> SAMPLE <br /> MEASUREMENT <br /> - . <br /> PERMIT ' <br />C: `. -"-_• REQUIREMENT =- 3DA A •: ': - "A I LY MX 110PdT <br />_ <br />- SAMPLE <br />MEASUREMENT <br />- <br /> -,177F 7F <br />• PERMIT <br />-7 <br />-ODA AVG <br />DAILY MX <br />i. ;;•{T <br /> REQUIREMENT <br /> SAMPLE <br />11; <br /> MEASUREMENT A1 + <br /> , rt., 1:; <br /> PERMIT r ._ <br /> REQUIREMENT T--!ST MAX = ?'a r <br /> SAMPLE <br />MEASUREMENT <br /> - a r -r,,t 1 <br /> PERMIT ' _ <br />" J's '?" REQUIREMENT 30DA A`, •_ CA ILY MX <br /> SAMPLE <br /> MEASUREMENT <br />` PERMIT <br />F _sODA AIJ':, DAILY MX <br />REQUIREMENT <br />NAMEfnTLE PRINCIPAL EXECUTIVE OFFICER ' fe"'ty ° r P.- My Wnew that this document and all altachments were TELEPHONE <br />Prepared under my direction or superrtsiou in accordance with a system designed DATE <br />to assufe that qualified personnel property Islher and erNusle the Information <br />submitted. Bred on my Inquiry of the person or person who manage the system, / _ ,? ---- <br />_ <br /> <br />w. <br />or those person directly respondbR for gathering the Information, the Inrormalbn <br />j . %. <br />% - submitted is, to the best or my knowledge and belief. tree, a rste. and compile. ' <br />IN <br />A <br />E <br />ECUTIVE <br /> I am aware that there are sign ille"t penalties for submitting raise information, CM <br />L <br />SIGNATURE OF ?R <br />X <br />T AREA <br />NUTAMR <br />YEAR <br />MO <br />DAY <br />TVDFt] OR PRINTED - Inehsding the possibility of floe and Imprisonment roe knowing e4olatiopa OFFICER OR AUTHORLZEO AGEN CODE <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference ed ettechmenb here/ ABLE <br />Z_ MON <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. <br />SOL ID LIMIT APPL IED FOR <=10YR, 24HR PRECIP EVENT- <br /> <br /> This 1S a 4-part fon-n PAGE OF ?-?.