Laserfiche WebLink
PERMITTEE NAME)ADDRESS (7-*i & F r0y N..WL -fion (/D(#itewar) <br />NAME <br />ADDRESS <br />BOX 483 <br />;IA CO 8142 <br />FACILITY E NO. 2 MINE <br />LOCATION •1 I A C O B 142 <br />I TAM A RV-AP IP . MTt,IF M(,FR <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM /WPOES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY Y AR MO DAY <br />FROM TO <br />Form Approved. <br />OMB No 2040-0004 <br />MINOR <br />(SUBR MH) <br />F - FINAL <br />sC ?H OF S <br />NOTE: Read Instructions before completing this form. <br />ELTA <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ANALYSIS <br /> SAMPLE <br /> MEASUREMENT <br /> W I S <br /> PERMIT t; ?` " # REPORT si r # ft ih it # it ?k n X u L F <br /> REQUIREMENT INST MAX <br /> SAMPLE <br /> MEASUREMENT <br /> <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 />PERMIT <br />REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER ' nrt"y ° r pt°"y ° law that thh document and .B .u.chment..t" TELEPHONE <br />prepared under my dire•cllon or super+islon In accordance with ¦ system ddMrd DATE <br />to asfure that auohned personnen property Sather and eralu.lr the Information <br />submitted. Bowd on my l"Wry or the person or persons who manage Ilse system. 1 <br />or those persons directly mponslbh for gathering the infornsatlon. Ike lnrornullon <br />i <br />mbntllted h. to the best or my knowkdge and better, Ime, aecurale. end complete. <br />F PRINCWAL EXECUTIVE <br />R <br /> I ant a- that then are significant penolms nor mbmstdng robe Information, SIGNATU <br />E O A A <br />NUMBER <br />YEAR <br />MO <br />DAY <br />TYPED OR PRINTED Including the poasiblllty of floe and ImpAsonment for knowing elel.llorm OFFICER OR AUTHORIZED AGENT CAE <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference off attachments here) <br />HR PP,FCIP EVENT IS CLAIMED. IF CLAIM APPROVED BY WGCD, <br />•RL=ME.t. I E=E i. P` t r. <br />HHQ <br />This- <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used 'DO ; is a 4-part form. PAGE OF