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PERMITTEE - NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) Form Approved <br /> Facility Name "' 1 DISCHARGE MONITORING REPORT(UMR) OMB No. 2000-0015 <br /> NAME f�l C <br /> UC r (2.16) (17-19) <br /> -- ^ .-�� ..___., t. _------- <br /> P. D. L•U ''J7 1.. I <br /> ADDRESS J_' <br /> ( 4VOD i^ ry,,r PERMIT NUMBER DISCHARGE NUMBER <br /> ---- CEltEb' , �U Ul1iDD 80215 -——————— _ <br /> ———— -------- MONITORING PERIOD <br /> EAS_IL— Golden Eagle Mine _------- YEAR I MO DAV YEAR MO DAY <br /> LOCATION FROM TO l <br /> -------- (20-21) (22-2.1) (24-25) 126-27) (28.29) (.10-31/ 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. FREQOUFENCY SAMPLE <br /> (32 37) EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS>< 62-63) (64-68) <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> C;(1i ' . • T(!� )' ' 1�, I MEASUREMENT <br /> PERMIT ; r p•,+ 1t1 <br /> ii tl ly REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT i.•(I, <br /> f REQUIREMENT <br /> y y r <br /> SAMPLE <br /> MEASUREMENT a 4 It /. u k V <br /> PERMIT <br /> :511 <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT « s <br /> J , 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 I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED TELEPHONE DA T E <br /> AND AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN; AND BASED <br /> ON MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR <br /> '�., I " OBTAINING THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION ��r <br /> David i.• aL ut IS TRUE. ACCURATE AND COMPLETE I AM AWARE THAT THERE ARE SIG- 1 /7 <br /> NIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION. INCLUDING '� T. <br /> .SiZV1�LTC.i L"i. lit 1.r� 1rCt]]Zc� C�� THE POSSIBILITY OF FINE AND IMPRISONMENT SEE 18 U.SC 4 1001 AND ( r� e <br /> 33 US.C.S 1319. (Penalties under these statutes may include fines up to $10.000 SIGNATURE OF PRINCIPAL EXECUTIVE 303 '93:, 50 i 031 <br /> TYPED OR PRINTED and/or maximum imprisonment of between 6 months and 5 years.) OFFICER OR AUTHORIZED AGENT AREAJ NUMBER YEAR MO DAY <br /> COMMENT AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) CODE <br /> hF ,I; � � : (.i Ili:;�'i li 1.1:,, i .,.. i :j t(rF'IaY1 j .11; F'f ►; 11,. �I � Ii i ' � ;, l ,,( r; :ki. (. 1t <br /> 1 0 <br />:PA Form 3320-1 (R 10.79) PREVIOUS EDITION TO BE USED (REPLACES EPA FORM WHICH MAY NOT BE USED.) OF <br /> UNTIL SUPPLY IS EXHAUSTED <br />