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PERMITTEE NAME/ADDRESS (Include Facility Nalne/Location if Different) <br />NAME IN-J'i IT E !7d!.SL, UR C ES Lt....C <br />ADDRESS B OLA TIE KID, 1 MINES <br />P. 3. TIOX 4•S 31 <br />P A0, F", i CO 8142a <br />FACILITY e' <br />s MT1 l? .s_°a <br />LOCATION CC) 81P?-28 <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES) <br />DISCHARGE MONITORING REPORT (D R) <br />005 A <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM it) 0 / Q TO 1,U I firs' ;;Q <br />M I NOR <br />( SUBR MI-1.) <br />F °- E' I NAL <br />Form Approved. <br />OMB No. 2040-0004 <br />.DEL,TP <br />I3I*i:H TO r. f-2i3A't"OAi= CRK <br />NOTE: Read Instructions before co pleting this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO• FREQUENCY SAMPLE <br /> OF <br />TYPE <br /> EX ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />1 ?9 SAMPLE 3£-•it•l#r4;.* i-=f 3 'E !? Td # is : 12) <br /> MEASUREMENT <br />?} Y ?1 PERMIT <br />#fi!?## <br />#r r 4z .w: <br />Kctii <br />,. <br />F <br />te?#4:-c? <br />". <br />ttC;? f <br />'It-+ <br />F '1`'1 - "= C,'R[3F7t"-s VALUE REQUIREMENT r ? 11,41 MUM MA 7i'?i <br />'•tw1_ <br />SOL 10 T E SAMPLE 3E??#`.c i'r# ;z; #tz? -"c #iir'-:=•KC1r ? !fit <br />_ <br />SUSPENDED MEASUREMENT - - - - <br />6 <br />r' <br />005-o t. f PERMIT b# # 1F t. d. k ? ### # # is rEg . W1 E1 Si D, <br />TEE LA.1EW 4 I'C nsgi VAj.L)-j: REQUIREMENT n.k#iz vYm1rA AVG- ADD: D 4}A, tt?, ?l C;??p?Zi <br />Ali) ? :: ; ? .,. t 3 SAMPLE n kS Eck # at, ?:• # #£ t, fiof' k »aaz t 25 <br /> MEASUREMENT <br />S an., PERMIT t''t1• ## r x'c# ..gnu ? 8#ii ##2z '• R"E- Fuji T 0.5 <br />FF Lr.,FNT 'TROSS VALUE REQUIREMENT <br />,DSt"i 1 ... S "} as <br />• E... <br />S S ? pF 1"7 <br />DIL AND asREA:.'1I'. SAMPLE #i•„### fi-'4 ?:ri;' i ait'i# °te 3 ?sb3i4fr:t C Ids3 <br /> MEASUREMENT <br />4Dte? G` PERMIT fib:°ielr$c# #? S. it•iv 1 #1# ##in# '?t ;E§••? tJ al?`r t. 1'I :: r7r1 <br />EFFLUENT tali OSS VALU . REQUIREMENT ki ? !> 4 ??f-?T )?? ': ?{a'% ?_ <br />FLOW, :'• ILi"'T?1 I.T. T SAMPLE t 03) <br />##3£ # f5 <br />i is # £f E <br />Ycti ?' li <br />T1: RU TREATMENT FLAW MEASUREMENT ` <br />! 5. PERMIT r '} s: a ?. _t'0! -0 L e T ?)•) <br />EF'F1._lBE l?! D 0,.9x3 VAL.LIL REQUIREMENT <br />1?r?' '' # D: <br />I} <br />3S 1 l°it <br />D 1} i„rw-i <br />):} L AND SAMPLE ?c,Lr fi• 3f $z : 94) <br />lk ,t •# a? <br />,? ?c# If # az <br />t• i' fi If 6 if <br />VISUAL. MEASUREMENT <br />5? vt =) PERMIT #,y; ### ....+ t'< #w t E x#1 €f 1z tf a» k }>£+ ttif#i Ti9 i t+t1¢il). <br />EFFLUENT 0'I2?C?artt1.r• VAd Ur- REQUIREMENT <br />t?=v <br />N <br />t ? f} } <br />i"?ONi H <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certify under penalty of law that this document and all attachments were <br />di <br />i <br />i <br />i TELEPHON E DATE <br /> <br />! lA, (M ?' ?/ ?"?• <br />/ / / prepared under my <br />rection or superv <br />s <br />on <br />n accordance with a system designed <br />to assure that qualified personnel properly gather and evaluate the information _ <br /> <br />/ <br />f r f * _ ! JJJ <br />(?(f <br />submitted. Based on my inquiry of the person or persons who manage the system, <br />_ <br />- or those persons directly responsible, for gathering the information, the information _ <br />_ <br />_ <br />j-jy? <br />.' MQ <br />? y ?• _ <br />submitted is, to the best of my knowledge and -belief, true, accurate, and complete. ,may <br />U _ <br />/? _ <br />? <br />( <br />v ! r t J <br />I am aware that there are significant penalties for submitting false information SIGNATURE OF PRINCIPAL EXECUTIVE J?• ?V <br /> <br />TYPED OR PRINTED , <br />including the possibility of fine and imprisonment for knowing violations. <br />OFFICER OR AUTHORIZED AGENT AREA <br /> <br />CODE <br /> <br />NUMBER <br /> <br />YEAR <br /> <br />MO <br /> <br />DAY <br />I WIV11VIG11 112 NIYLJ r_ArLN171\ 1 KJIV Vr M14 I V IVLN I IVIM0 (r7C1VrV11(:C till d1lac;11111villb flurv) <br />;.'',?,."1'DL.,EA131.- FOL-103 L,10,XT WAIVE-ED FOR 10-`€R, 24HR FRECIP EVENT SUBJECT TO BU4 DSN OF PROOF 1?EOUIREMENTS IN <br />PART T. _. 45. ANY ADDIT.TONAL DATA HALL~ a.?`= SUPPLIED TO THE DIVISION WITHIN 48 HOURS. <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. 0(?OSTt/OT li'S 1S r4 part form. PAGE