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d Mine INITORING PERIOD
<br /> rAtel My ______ YEAR MO DAY YEAR 1 MO DAY
<br /> U2CA7ION MontroseCounty,roTorado------- FROM 1 TO
<br /> ( - ) ( ) ( 4- ) ( I. - I (j - ) NOTE: Road Instructions before Completing this form.
<br /> (3 Card OntY) QUANTITY OR LOADING (1 Card On/r) QUALITY OR CONCENTRATION
<br /> PARAMETER (16-J3) (J4.61) (38-/5) (4643) (54-61) NO, /MCCUtNcr SAME
<br /> (JJ-37) EXANALO/r91• TYP
<br /> >< AVERAGE MAXIMUM UNIT* MINIMUM AVERAGE MAXIMUM UNITS 61dJ) (61.") (69-71
<br /> SAMPLE
<br /> FLO; (cFF;,�E �T) MusUREMENT NO 0 CHARG * * + * * +
<br /> PERMIT 'J'r '• •
<br /> REOU/RW ENT I} i
<br /> r SAMPLE
<br /> 2LI:s • T':T"L C(,JCD MEASUREMENT
<br /> P•utrftr^ L�/•:•� ''G/L
<br /> REaus"KIN VE MIr
<br /> SAMPLE
<br /> IR0igI,T0TSL MEASUREMENT t * #
<br /> 0 1 7�5 "REour:Rsa•Errr-• � yIr ,� ir' :� �* Tt SP- �w �h t �- 'j^'�'-' .r;'11", ,.- _, a,�" �,i=(F - 1"
<br /> SAMPLE
<br /> PH.FIEL) MEASUREMENT
<br /> 3 U -
<br /> 0 0 4 v^ REOu[REa•ENr' -F' 7)1'... yF yr- '>r- �► t 6 �l[-'''/!�' lf°"-*- ?" - : 4' ::
<br /> SAMPLE - -
<br /> '-'OIL & GREA3E MEAauREMwr
<br /> V 13 u A L PW" z;;:,`, r ro �-, a G/L
<br /> 0 A G Ml4t1tRENENI?`
<br /> 2 °ll,,.,:t s » �Ir .�w �+r yr ,,. ,r,:>#,: I°C �._.,,. . •"3u V
<br /> SAPLE
<br /> C.^r�'1000TIVITY %/,;R MEASUREMENT
<br /> T 3 (E F F L tJ E:,;T)
<br /> 4�t i �yliati77lEMf1MT •+„='s,w.. .,:. .: .. :.."..:. �<.. �.' .;..:< 'x..�n..- 'w � ..`r«'; ,.
<br /> "',M:�',)r .Ip�,>r,` ,�-,'.,r,.>•�t- �• � yr � ir � ,r-''i�r..:�t• - •,r• tt^'ir :>�Y- it�il'- v"
<br /> *AMPLE -
<br /> MEASUREMENT -
<br /> .< PRHMf7",-•ice i• �:,�'.'.�<^p�. ✓- ._ ... '.t'• .• �, `,a:,� •,'�`F:A.. '�:
<br /> NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PgP"LTY O/ LAW ntAT I HAVE KRSONALLY EXAMINED _ TELIPNONE O A T
<br /> AND AM FAMILIAR WITH THE INFORMATION SUO"YTLO NCMIN AND SASLD
<br /> ON MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONVELE from
<br /> OBTAINING THE INFORMATION. I sEUEVE THE SUBMITTED iNrORMATON If/ JJ
<br /> H. Theodore Smith IS TRUE, ACCvRATE AND COMPLETE I AM AWARE THAT THERE AMC SIG N, JVJL�
<br /> NIi1C'ANT PENALTIES FOR SUBMITTING FALSE INFORMATION INCLUDING ��'„•"`�++�+���iVV�-iCCJ/J' �G l0 �t
<br /> Hydrologist THE POSSISILITY Or FINE AND IMPRISONMENT SEE I6 U.SC 1 1001 ANO SIGNATURE OF PRINCIPAL EXECUTIVE 6021 77 14-5253 V
<br /> 33 U S C 1 13 19. tPrnaltue Iron them statutes evev. —hide /aver, up to ffa(NNO
<br /> TYPED OR PRINTED aN'nr menu-uwv ItwPn MA Pwwt„/A►tuava i~.&A.evo/S.w rat OFFICER OR AUTHORIZED AGENT NUMBER YEAR MO DA
<br /> COMMENT AND EXPLANATION OF ANY VIOLATION* (Re/erence all altuchnventl here)
<br /> IF ".0 0I3CyaRGE OCCU?RE1J ^.U-jI'vG T-iI9 ZE?ORTI '1G ;:E?I:.'7 REFCiT B-.10 OISC1a9GEII
<br /> EPA Form 3320-1 (Rev. 10-79)PREVIOUS EDITION TO BE USED (REPLACE* ETA FORM T-40 WHICH MAY NOT OE USED.) PAGE OF
<br /> UNTIL SUPPLY 18 EXHAUSTED
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