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PERMITTEE r,,. NATIONAL POLLUTANT DI ARGE ELIMINATION SYSTEM (NPDS) For 'pproved <br /> Facjlity Aarn I:..:,;, f.DISCHARGE � ORING REPORT (DMR) 0 2000-0015 <br /> NAME (2 <br /> I LACE --------- 161 (17-19) <br /> O. DO" 15.- <br /> PERMIT NUMBER JDISCHARGE NUMBER <br /> 1 <br /> COLORADO 80215 --------- I <br /> ————————— MONITORING PERIOD <br /> FAC—IL!-T-Y— Golden Eagle Mine ————————— Y£AR MO DAY I DAY <br /> LOCATION_ --———————— FROMI I i' I I TO YEAR MO <br /> (20-21) (22-21) (24-25) (26-27) ON 29) (m-31) NOTE: Read instructions before completing this form. <br /> (3 Card Only) QUANTITY OR LOADING (4 Card Only) QUALITY OR CONCENTRATION <br /> PARAMETER (46-53) (54-61) (38-45) (46-53) (54-61) NO. FREQOFUENCY SAMPLE <br /> (32-37) EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> >< (62-63) (64-68) (69-70) <br /> SAMPLE <br /> MEASUREMENT <br /> V I 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 /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> NAME/TITLE PRINCIPAL EXECUTIVE OFFICER ' CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED TELEPHONE D A T E <br /> AND <br /> AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN AND BASED <br /> ON MY I NQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR <br /> OBTAINING THE INFORMATION. I BELIEVE THE SUBMITTED INFORMATION <br /> TRUE. ACCURATE AND COMPLETE. AM AWARE THAT THERE ARE SIG <br /> NIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION INCLUDING <br /> t'-:j THE POSSIBILITY OF FINE AND IMPRISONMENT SEE 18 USC § 1001 AND <br /> 33 U.S C §1319, 'Penalties under these statutes may include fines up to $10,000 SIGNATURE OF PRINCIPAL EXECUTIVE <br /> TYPED OR PRINTED and,or maximum imprisonment of between 6 months and 5 years.) OFFICER OR AUTHORIZED AGENT LAREA NUMBER YEAR MO DAY <br /> F IODE <br /> COMMENT AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br /> I I I t Gi <br /> PA Form 3320-1 (Rev. 10-79) PREVIOUS EDITION TO BE USED (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE OF <br /> UNTIL SUPPLY IS EXHAUSTED <br />