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PERMITTEE NAME/ADDRESS (In ch-LFaiAtryN?.JLerason t/DIOG+mI <br />NAME <br />ADDRESS <br />ii JA 46j <br />AIA C0 8142 <br />FACILITY -,II E NO. MINE <br />LOCATION ..IN I A CO 3142 <br />. ; LLIAM A. BEAR JR., MINE MGR <br /> <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM /rNPDESI <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER as Hmw NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />MINOR <br />(SUBR <br />MH) <br />F - F INAL <br />MINE DRAINAGE <br />Form Approved <br />OMB No. 2040.0004 <br />NOTE: Reed Inetructlons before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY SAMPLE <br /> OF <br /> EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE _ <br /> MEASUREMENT <br /> PERMIT rte its#? ### ;: _.. ,! _. . <br /> REQUIREMENT MINIMUM I•t X I MUM <br /> <br /> SAMPLE <br />MEASUREMENT <br />'. <br /> <br /> PERMI T, ,vim <br />T7 r: -- <br />7?7 <br /> REQUIREMENT -1ODA ?,vti? CIAiL r' Nf, MON Ts-: <br /> <br /> SAMPLE <br />MEASUREMENT <br /> <br /> PERMIT :r 0, u <br /> REQUIREMENT 30DA DAILY MX MONTH <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT xx sr .: -: x = . <br /> REQUIREMENT i NST MAX GENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT ? r <br /> REQUIREMENT JPA 4. Lit`, I L 'r' MX <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT IST MAX <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />:1 <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I Gerdy under pens ,, o I.. that this d-nwnl and .11 ¦11"hmenu wen - <br />TELEPHONE <br />d <br />d <br />l DATE <br />mpql <br />pr <br />un <br />e <br />er my dtreuon or <br />[l <br />M In aeeordsner with a system deainee <br />M <br />l P <br />"P <br />to JIM- that rJu.Nikd personnel properly gather and eeatuate the Information <br />Submitted. Band on my Inquiry of the Person W Peron0 who manage the [ysterm <br />of those Persons dlreclly mpa dble for gathering the Information <br />the Information --' - <br />, <br />Submitted is, to the heft of my knowledge and belle( <br />tyre <br />Ke ursle <br />and com <br />ile <br />, <br />, <br />p <br />. <br />. <br />1 <br />I ¦m swam that them arc sigNBesal Penattia For.rbmllting (site Information <br />SIGNATURE OF PRINCWAL EXECUTIVE <br /> , <br />InAudln <br />th <br />lblllt <br />f n <br />e <br />d I <br />is AREA <br />TYPED OR PRINTED t <br />e Poa <br />y o <br />n <br />an <br />mpr <br />onment for knowing riolatiom. OFFICER OR AUTHORIZED AGENT 1 ODE NUMBER <br />C YEAR MO DAY <br />GUMMGIY I J ArsU [ArLPkr/n I nvr yr n... ..v?rs r ,vna <br />r?ncSr am wu?uwnwn is rrAe/ <br />WSTRUCTIONS - I. C. 10, PG. 10. <br />EPA Form 3320.1 (Rev. 3/99) Previous editions may be used. --'.-' '' TWS is a 4-part form.