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PERMfME NAME/ADDRESS (7w&&F rwry)Va.?L e&ti . tfD(foram) <br />NAME <br />ADDRESS <br />bux 187 <br />.IG CO 81626 <br />FACILITY ' :.;'PER MINE <br />LOCATION I G CO 81625 <br />?mnw) a f)tl ADIS, PRES/GM <br />NATIONAL POLLUTANT OISCHMGE ELIMINATION SYSTEM JNPOESI <br />DISCHARGE MONITORING REPORT ID R) <br />PERMIT NUMBER DISCHMGE NUMAgri <br />MONITORING PERIOD <br />YEAR MO DA Y R MO D &Y <br />FROM TO <br />Form Approved. <br />OMB No 2040-0004 <br />MINOR <br />(SUBR JC) <br />F - FINAL <br />POND #1 TO UTE GULCH <br />NOTE: R*ad Irmtrue'tlorw bofort?complotinp thb form. <br /> <br />PARAMETER <br />QUANTITY OR LOADING <br />QUALITY OR CONCENTRATION NO <br /> <br />NO. <br />FREQUENCY <br /> <br />OF <br /> <br />SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT v t_ <br />f_ N f .f REQUIREMENT M I N I r1Uh1 MA X I MUM <br />•- SAMPLE <br />Pr'NDFD MEASUREMENT <br /> PERMIT <br />. i.. <br />r'• L' <br />REQUIREMENT <br /> <br />+ODA VG <br /> <br />DAILY NX h1C+NT <br /> SAMPLE ,- <br /> MEASUREMENT <br />5 1 O O PERMIT "U <br />30DA <br />DAILY !11Y <br />MONTH " 1' <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />- REQUIREMENT I 30W AVG <1ILY MX <br /> SAMPLE <br /> MEASUREMENT <br />c: PERMIT f... .. ;... <br /> REQUIREMENT :;,!'.ST MAX GENT <br /> SAMPLE I <br />Pi- MEASUREMENT <br /> PERMIT - 57W T, <br />^: = REQUIREMENT :30DA AV(? DAI L?, MX <br /> SAMPLE <br />" r' MEASUREMENT <br /> PERMIT , <br /> REQUIREMENT 30DA AVG L :'_.I LY MX <br />NAMERiTLE PRINCIPAL EXECUTTVE OFFICER t "-y . nder pen. ty o I.w that th <br />re <br />ared under my direction " mp b documrm -d .11 .11-ho-o" ware <br />rmtsion In accordan" with a System designed TELEPHONE DATE <br /> p <br />p <br />to ire th.l yuanned per ncl properly other and evaluate the Inromnooon <br />mb olited. Based on me Inquiry of the person or persona who manage the mtem. <br /> or thosa persona directly respon.dble for gathering the Information, the Information ?/ <br />` - - <br /> to the best of my knowledge and belief <br />true <br />accurate <br />and complete <br />mbmitted Is i <br /> , <br />. <br />. <br />. <br />. TVRE OF PRINCIPAL EXECUTIVE <br />I <br /> 1 am swam that there and Significant penalties for submitting M1br Information. S <br />GNA ARIA <br />TYPED OR PRINTED including the possibility of mar and Impr4onmant ror knowing rloetlo OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANA I IUn yr Ara T vrv%_^ n nvraa rrea7l/Ir)cI are, <br />ABLE SOLIDS LIMIT APPLIED FOR <i=IOYR,24HR PRECIP EVENT- <br />- <br />EPA Form 3320-t (Rev. 3199) Previous editions may be used. r'rl 1 C.:? / _TI1?B tS; it;Q p4krUfOrtn. PAGE OF /1