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PERMITTTE NAME/ADDRESSQnr?irF?eikryN?..'L«?n?t(?DI?G.wt4 <br />NAME <br />ADDRESS <br />i•iEFKr-R C <br />FACILITY F MINE <br />C <br />LOCATION <br />k.,p 017 <br />NATIONAL POLLUTANT OISCHMOE ELIMINATION SYSTEM INPOESI <br />DISCHARGE MONITORING REPORT ID RI <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY Y R' MO DAY. <br />FROM TO <br />Form Approved <br />OMB No 2040-0004 <br />STRFIF i ER GULCH TO GCC l) SPGS <br />NOTE: Read kwtrucdorw before compl*ting this form. <br /> <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, <br /> <br />EX FREQUENCY <br />OF <br />ANALYSIS SAMPLE <br /> <br />TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />MEASUREMENT 7, ?. <br /> <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br />MEASUREMENT <br /> <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br />MEASUREMENT <br /> <br /> PERMIT <br />REOUIREMENT <br /> SAMPLE <br />MEASUREMENT <br /> <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br />MEASUREMENT <br /> <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br />MEASUREMENT <br /> <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br />MEASUREMENT ?J <br /> <br /> PERMIT <br />REQUIREMENT <br />V OFFICER 1e"i1' under penalty of ow that 1 Altdo im,m and it .tt.ch mrnts were TELEPHONE DATE <br />E <br />NAMEMTLE PRINCIPAL EX CUTI <br /> <br />. prepared under my dlrt 11- or superstsion In accordance with . system deslgrrd <br />In assure that qualified Personnel Property gather and rsalu.lr the Information <br />nrbnt111ed Bred on my Inquiry of the Person or perwm who mon.tr the system. <br />or those perwns direetty responsible ror tethering the Information, the Inroneallen <br />/ <br /> <br />. • <br /> <br />/ <br />` r <br /> <br /> <br />t ; <br />I 1 <br />1 <br />A Rlbmllted K to the belt *(my knowledge and belIK I-,. a row and somplHt. <br />TIW <br />/ I am .ore that there are significant pe-lde for -bmllttng f.W Information. SIGNATURE OF MINCWAL EXECU <br />FICER OR AUTHORIZED AGENT AREA NUMBER YEAR MO DAY <br />TYPED OR PRINTED Including the poalbitlly or flrr and Imprisonment for knowlmt rtdatbrsi OF CODE <br />COMMENTS AND EXPLANATION OF AIVT vIVLA 1IVrr5 Irtereronc• arrr r/"'""rrw"'° ••w"' (HR PR1=C iP EVEN'. 1. ?.L-H.:"tGU, t r t,L_n a r t r <br />r -. ry 'Z 1'(??-' rll <br />This t5 a 4-par (orln y4GE OF <br />EPA Form 3320-1 (Rev 3199) Previous editions may be used.