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PERMITTEE NAME/ADDRESSpnrY6fetWryNam?L«wi-(fDoWvw) <br />NAME <br />ADDRESS <br />BOX 4.83 <br />IA CO E3142f <br />FACILITY E 110. 2 MINE <br />LOCAT10N JA A CO 8142E <br />_i_IAM A. DEAR JR. , MINE MGR <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM INPDES/ Form Approved <br />DISCHARGE MONITORING REPORT /DMR/ OMB No 2040.0004 <br />PERMIT NUMBER k=ZGE NUMBER _ F T NAI- r <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREOVENCY SAMPLE <br /> OF <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT , <br />y <br /> REQUIREMENT <br /> A,X <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT " <br />l di- <br /> REQUIREMENT ! '! f'i I`SCIi <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT ?• <br />MONTH <br /> <br /> SAMPLE <br /> MEASUREMENT <br />_i PERMIT <br />-; - <br />- REQUIREMENT <br />rJTH <br />11 SAMPLE <br /> MEASUREMENT <br />f 1 PERMIT <br />! <br />E N- REQUIREMENT <br />ti , X I ; SAMPLE <br />?qI MEASUREMENT <br /> PERMIT r'.FPORT REPORT f ; fr. .. = • a <br /> REQUIREMENT A hk, r!;? I LY MX <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> <br />PERMIT ,r; ,E-r a rt <br />1 _.', - <br />4 <br />15 UAL <br />REQUIREMENT <br />I [ <br />Is were <br />NAMEf"nE PRINCIPAL EXECUTIVE OFFICER 1 mr"'y "der 0-c" Fly o aw that this dacumenl and aA Misch <br />TELEPHONE <br />DATE <br />pmp.md under my directlon w supervision in accordance with • systern designed <br /> to assure that quality d personnel properly gather and evalu.te the Information <br /> submitted. Bred on my inquiry of the person w Persons who manage the system. <br /> or thaw persons; directly resporMbls for tethering the Information, the Information <br /> submitted Is, to the best of my knowledge and belle(. Imes @-umfe. and rompkte. <br /> I am swan that they: are significant penalties rot submitting false Information SIONATURE OF PRINCNAL EXECUTIVE <br />TYPED OR PRINTED , <br />Including the porlbmry of nne and Imprisonment rw knowing riul.tko OFFICER OR AUTHORIZED AOEIfT CAREA ODE NVMBER YEAR MO DAY <br />AND EXPLANA I IVn Vr Ant <br />nerve <br />SETTLEABLE SOLIDS LIMIT APPLIES ONLY IF =I0YR,24HR PRECIP EVENT IS CLAIMED. IF <br />TSS & IRON LIMITS WILL NOT BE APPLIED TO REPORTED MEASUREMENTS-SEE I.A.3, PP 4_R <br />IIICI <br />EPA Form 3320-1 (Rev 3.199) Previous editions may be used This IS a 4-part form. PAGE OF