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PERMITTEE NAME/ADDRESS /lnr(udr Faritiry A'arndl~catinn if Ui/Jrrrnfl <br />NAME - _ ~ i, 1_! G <br />ADDRESS _ . ~ i`i . i .;:. <br />~'~ ~2t3 <br />CO 81424 <br />FACILITY ~ , Soft I ~ ~N I`l I IVE <br />LOCATION ~ .A ~ ~ ~ Z $c4 <br />LANCE WADF, MINE MAIVA~ER <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEA M DAY <br />FROM TO <br />Form Approved. <br />OMB No. 2040-0004 <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION P10, FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> i AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE ! • <br />;;_ MEASUREMENTi <br /> PERMIT ~ ~ r :-; <br />', . ~_~ REQUIREMENT :CODA AVM DF1? ._Y MX ; , <br /> SAMPLE • F <br /> MEASUREMENT <br /> PERMIT tr ~ :: x'.~ :r t r f -: <br /> REQUIREMENT '~:)J.~A FO'JG J~, f ! <br /> SAMPLE <br /> MEASUREMENT <br /> PERM17 !z ~ ,. ,. ,r ! r.Cr i~r ~ , <br /> REQUIREMENT :~:~Da fi':/~ Of31L'i ~'~ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ' ~ ~ _ , . a t <br /> REQUIREMENT 3t.L~r. ^,~'~ u~l[1_'r' +~ ; <br />' SAMPLE <br />r °c-~ ~~ <br />. ~'J ~I'Jti v:_L' MEASUREMENT <br />',!-;C?f, 1 PERMIT 'n <br />:~ <br />r' <br /> REQUIREMENT aCi`1A Fl'~ ~= fJri ILY t iX. <br />"` SAMPLE <br /> MEASUREMENT <br /> PERMIT - . _ _ . , <br /> REQUIREMENT )GDP. A V ~.~ ;_`A I LY •.:._ • ~ - ! <br /> SAMPLE ~ <br /> MEASUREMENT <br /> PERMIT .. rr._-' < ~ - - ' <br /> REQUIREMENT ~~ ;,,; -. _... ':~:'~' i. ;% ~.r : MQF•t <br />NAMElfITLE PRINCIPAL EXECUTIVE OFFICER I crrtiH under prwdn ~r mw that mis dxument aad an ~nYChmrnt.++err TELEPHONE DATE <br /> prepared ur,drr m~ direction or wprr+iJon in acairdrnec with a +~stem desiRmd _ _ _ -. <br />-- <br /> to a+surc that yuolifird prrumnel proprriy Kuthrr and e+aluale the information ~ , <br />~_ _ __ ~ ,-- submitted. Busrd on m~ inquire id thr prrum ur pcrwns who mana;;c the s~slern. ~ _ <br />~ <br />~ ~ <br /> or thou prrnom diratl~ nrponsible far ~athrrin>; the information, the infurmaliw, '"•--- <br />~- ,t _ <br /> wbmitted k <br />to the best of my knowirdKe and hrlirf <br />trur <br />accurate <br />and eomplete ~ <br />~ r '1 <br />~ , <br />, <br />, <br />, <br />. <br />i SIGNATURE OF PRINCIPAL EXECUTIVE "" <br /> <br />, TYPED OR PRINTED 1 am aw arr that thcrc are +i¢nificaat penrlties for +uhmittinR falsr infurntat <br />rm, <br />inclueinu thr posihdih or fine and imprisonment for I;nuwin>Z,iolation+. <br />OFFICER OR AUTHORIZED AGENT AREA <br />ODE NUMBER <br />YEAR <br />MO <br />DAY <br />COMMtn15 AIVU tJCYLAIVAlIV1Y VI' AI`IT VIVLAIIVtYJ Inerrrrncr an iynacrrnrrms nrrr~ <br />FAGE OF <br />CPS nor->, 35~2~~ 1 ~Rc: _ v9; Fr?v~~_~u~ ec~!i:~ns ^~~, - -- ~ lii~ {, a -~-Hart 1<tl n'- <br />