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PERMfTTEE NAME/ADDRESS (7..&k)w&ryNa,.wLerae,enyD(prwq <br />NAME <br />ADDRESS <br />LUf. <br />,G CO 81626 <br />FACILITY PER MINE <br />LOCATION : G CO 81625 <br />"MOND G. DU BOIS, PRES/GM <br />NATIONAL POLLUTANT OISCHARGE ELIMINATION SYSTEM ((NPDESI <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER &scimGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved. <br />OMB No. 2040-0004 <br />!•i .. i'?Cil <br />( SUB F• <br />F - FINAL MU <br />POND #5 TO NO NAME GULCH <br />NOTE- Reed Irrtn,rNeri hatfnes em-lastlnn this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ, FREQUENCY SAMPLE <br /> OF <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE <br /> SAMPLE <br />MEASUREMENT <br /> <br /> PERMIT #ff#If REPOR " +?### # #####ic #### # tdCE/ it <br />iv ' REQUIREMENT I NST M;; MONTH <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 /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br />PERMIT <br />REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER p ' ferirepa" re y d " ordof er my dl my direction orwer that 10p- d« on in 'in accor andd a n n'ca e with ame sys le m ere designed TELEPHONE <br />+lsi _ <br />- DATE <br />?- <br />- - - <br />- to assure that quallned personnel property [ether and evaluate the Inrorrnallon <br />swbmllted. Bored on m <br />in <br />uir <br />of the <br />erson or <br />r <br />who <br />n <br />th i % <br />-" <br />, y <br />q <br />p <br />pe <br />y <br />ma <br />age <br />sons <br />e system. <br />ar th <br />dir <br />tl <br />n <br />lbk f <br />h L-- <br /> ose persae <br />ec <br />y mPo <br />s <br />or gat <br />ering the Infoernelloo, The Informo6on <br /> submltled k, b the best of my knowledge and beW. Irw. accurate, and complete. . .. <br />• - , - <br />:.._ <br /> t am aware that then are signincant pertairks for submitting raise Infoernatlon, SIGNATURE OF PRINCMAL EXECUTWE <br />TYPED OR PRINTED Ineluding the possibility of line and Imprisonment for knowing .iolaUom OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />. UMMCl? 1 J Arvu C/r l.nnn r sure yr n.e . .... ?....vre.r rr.wrwrw ruse son wrasc.rrrnvna nwraq <br />-ABLE SOLIDS LIMIT APPLIED FOR <=10YR,24HR PRECIP EVENT- <br />-:i; _ )S MONITORING - 1.8.2, <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. ) 0060 / 1USA114-par(orm.