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PERMRTEE NAME/ADDRESS f7-A.& i.rsBgNaas Garatl..I/DW..er) <br />NAME <br />ADDRESS <br />r3UA A1Jl <br />G CO 81 <br />FACILITY ,'PER MINE <br />LOCATION I G co 81 <br />`r"MOND G. DU BOIS, PRES/GM <br />NATIONAL POLLUTANT OISCHAA0E ELIMINATION SYSTEM (/NPDESI <br />DISCHARGE MONITORING REPORT IDMR) <br />PERMIT NUMBER otscHAROE NuMeE>, <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO - <br />Form Approved <br />OMB No 2040-0004 <br /> <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREOUNCY <br />OF SAMPLE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE <br /> SAMPLE <br />MEASUREMENT <br /> PERMIT ##### <br /> <br />REQUIREMENT FtLpORI <br />I NST MAX <br />40 -U # # ## ##3t## itn#### ,n I, F! <br />I.IONTH 11;,.a <br /> SAMPLE <br />MEASUREMENT <br /> PERMIT <br /> <br />REQUIREMENT ` <br /> SAMPLE <br />MEASUREMENT <br /> PERMIT <br /> REQUIREMENT i <br /> SAMPLE <br />MEASUREMENT <br /> PERMIT <br /> REQUIREMENT i <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 />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I ""'I-`' of pen"y ° law that Ihb dorument and all ¦tlachments .ere <br />Prepared under my direction or supee vi on in aecordsrtce with a system designed <br />is a m that <br />oatlfW <br />t <br />ers <br />n <br />l <br />- TELEPHONE <br />DATE <br /> <br />.. <br />. <br />.. <br />" <br />; <br />; <br />; proper <br />g <br />p <br />on <br />e <br />y galber and evaluate be information <br />s°bmttled. Band on my In gWry of the person or persons who manage the syelem, <br />or those persons directly responsible for gathering the Inforwutlon, Ike Information <br />submitled I& to the best of m <br />k <br />i <br />.?. <br />-, ?- <br />?l <br />' y <br />now <br />edge and belief. Ime. accurate, and complete. <br />I am aware that then are signs knat <br />e <br />ltl <br />f <br /> <br />" p <br />na <br />es <br />or submitting false Information, SIGNATURE OF PRINCIPAL EXECUTIVE - <br />TY <br />PFt <br />TED <br />D <br />PE <br />rnu.AC&l- Aarn FYOI ANATInN e)F ANV Vint Incfudlrlg the passibility of Am and Imprisonment for knowing violations <br />ATIna1e OFFICER OR AUTHORIZED AGENT A A NUMBER <br />CODE YEAR MO DAY <br />TSS $c TOTAL IRON LIMITS WILL BE WAIVED, `FABLE SOLIDS LIMIT APPLIED FOR <br />SEE BURDEN OF PROOF REQUIREMENTS UNDER ! TDS MONITORING - I.B.2. <br />LOYR,24HR PRECIP EVENT <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. r7l Q 1 20 i (IftS.l6.$.4-putt forin. PAGE OF