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PERMITTEE NAME/ADDRESS lInclude FarifitT:vamr/Luratioa i//hJferenrl NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />NAME - DISCHARGE MONITORING REPORT (DMR) <br />' ADDRESS <br />il. L' CJ it ~ . PERMIT NUMBER DISCHARGE NUMBER <br />_ICL~ MONITORING PERIOD <br />FACILITY : ~ NQf7 ;. Z ~' I': i`l i I ~i ~. <br />LOCATION . ,UCLF- CO >_' FROM YEAR MO DAY TO YEAR MO DAY <br />`Z. L14t~tCE WABF_, MINE MAl~kOF <br />Form Approved. <br />OMB No. 2040-0004 <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ, FREQUENCY SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />i MEASUREMENT <br /> PERMIT :. ;. -::; : ~ r. fly . ,, <br /> REQUIREMENT <br />.v''. <br />~{ i i It <br />_ <br /> SAMPLE -- _ <br /> MEASUREMENT <br /> PERMIT ~ :.: x- ... `c E> •U~:. <br /> REQUIREMENT _.,~ j t y ~ , .. :. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT /: ~ • ~ -:: T ~,- R:-L~::,_, r - <br /> REQUIREMENT ~~: G u~ 1 L.'; r?': ;-'; ~ . <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ,- r s,` ~; si• ;; s: #3i _. ~- t_:i~! <br /> REQUIREMENT ?API i L'r' i~iX <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 />NAMElTITLE PRINCIPAL EXECUTIVE OFFICER I eertif~ under penalt\ Id IY» thw thb dowmmt aml all mwrhmrnt\ Nere <br />d <br />f <br />i <br />i TELEPHONE DATE <br /> prepare <br />unt <br />er m\ d <br />ntiaion IK •ulx•rvi.ion <br />n aceurdanee NiW a \}nam de.i;;nrd <br />----- <br /> hl a wm That yuulified personnel properh tvdlhcf Ylld a\YIWIe lhr InrormYtYM ' <br /> <br />- ~ wbmittrd. Ravel on m) inyuin .Ir the prrMM Ur perWn NI/U mY1W((e the \\\tem. ~ ~.~ <br /> or thou prrvHC\ dimtl~ responsibly fur Rathrrirlk the infortmlion. the informaGan j ~ - <br />r <br />' - ~, <br /> <br />\ubmiurd is, to the hea or m\ knoNled~e and brlief, true, accurate. and complete. , <br />1 <br />~ <br />~ <br /> <br />I .Im a.. arc That tlu-rr Yrr si <br />nifn~ant <br />enaltie. roc wbmittin <br />r <br />lx i <br />r <br />[i SIGNATURE OF PRINCIPAL EXECUTIVE = <br />` - 1 <br /> <br />TYPED O 'PRINTED ~ <br />p <br />K <br />a <br />n <br />urma <br />un. <br />m~ ~ulho~ Ri\ p~•.~ibdin of finr and impriummrm fur Am\Ning \ildationc, <br />OFFICER OR AUTHORIZED AGENT <br />AREA NUMBER ' <br />CODE <br />YEAR <br />MO <br />DAY <br />l.V1Ylm Gn l.a nl.v r_nr Vr+l.e+llvn yr Mf\1 YIVLMIIVI\J I/lClC/CIIGC tlt/4lIt1GI1!!!ClIIJ !!C(C/ <br />`11i• i. .1 -: i~ari li,ril~ PAGE <br />