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PERMITTEE NAME/ADDRESSIywdrfrF rihtyNam?Lorafl-(/DlQlrr q <br />NAME <br />ADDRESS <br />Pru.& 46J <br />.,NIA CO 8142E <br />FACILITY 'I E NO. 2 MINE <br />LOCATION NIA CO 8142E <br />LL I AM A. BEAR JR . MINE MGR <br />Form Approved. <br />NATIONAL POLLUTANT OISCHAROE ELIMINATION SYSTEM JNPOESI OMB No. 20400004 <br />DISCHARGE MONITORING REPORT /DMR) <br />1. <br />?'IJBF H <br />PERMIT NUMBER DISCHARGE NUMBER - F I NAL DELTA <br />MONITORING PERIOD DSGHG OF SR TO GUNNISON RIVER <br />YEAR O DAY Y MO DAY <br />FROM TO ' <br />NOTE: Read Instruction before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. <br /> <br />EX FREOVENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT a### ..f:??F :;) r t <br /> REQUIREMENT MINI MUM MA X I MUM <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ##it# ; ?r'?r## ## # _ f <br /> REQUIREMENT 30DA r"• -.. DAILY Mk it7FdT14 <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT # # # #####if REPOR REP OR T' <br /> REQUIREMENT 30DA AVG DAILY ti:e 3TE' <br /> SAMPLE <br /> MEASUREMENT <br />5 PERMIT # ##it## irsryt##ir 6000 i AcE/ <br /> REQUIREMENT 30DA AVG DAILY MX MONTH <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ,t IF# iE#it### i r ON C i?. <br /> REQUIREMENT I t••iS T MAX - I + T <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT POP T REPORT <br /> REQUIREMENT A = ILY MX <br />-• SAMPLE <br /> MEASUREMENT <br /> PERMIT ra <br /> REQUIREMENT ST MAX <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I cendy under Pen. ty 0 I.. that th <br /> <br />P••P•t•a ardor my direction or sup is document and .o allachm <br /> <br />erehlow In oceord.nce Ilh ents rere <br /> <br />. system designed <br />TELEPHONE <br />DATE <br /> to "sore Ihot guollnetl Personnel property gather and evaluate the Informalbn <br /> .rived. Dowd on my Inqulry of the person or per.om -ho manage the system, _ <br />- <br /> Ml. Persons dlreeny respordblr for i.thertng the Information, the Information <br /> submilted Is, to the best of my kne gt and belle(, tyre, a rale. all compkle. <br />th <br />t th <br />e a <br />l <br />ilk <br />t <br />e <br />ld <br />f <br />bmitti <br />fal <br />l <br />tl <br />1 <br />f <br />SIGNATURE OF ?RINCIrAI EXECUTIVE F=' <br />-' <br />TYPED OR PRINTED am aware <br />a <br />er <br />re s <br />Er <br />an <br />p <br />na <br />" <br />or su <br />ng <br />se <br />n <br />onna <br />tm, <br />lneiudln& the po"dbilily of fine and ImpAsoamenl for knowing vlolatlorn OFFICER OR AUTHORIZED AGENT AREA <br />CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference elf attachments here/ <br />OAR Pr?" C Ii7 FVFtQ F IC3 CI-ATMFD rF CL ATM APPROVF0 P',' W-, Cr-3, <br />EPA Form 3320-1 (Rev. 3/99) Previous editions maybe used TNS ;IS a 4-Part (arm PAGE OF