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PERMITTEE NAME/ADDRESS Unclude Fac", NamelLocation if fhfferenti <br />NAME <br />ADDRESS <br />..70 <br />CO 8163 <br />FACILITY <br />LOCATION DEN CO 8163 <br />`f' KARO) RECLAMATION MANAGER <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />FROM YEAR MO DAY TO Y AR MO DAY <br />Form Approved. <br />OMB No. 8040-00040 <br />MINOR <br />i 5VBp. C <br />F - FINAL ROU <br />DISCHARGE TO SAGE CREEK <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE [ ` T / , i1 L f <br /> MEASUREMENT ?/ J V L/ In <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE I <br />? <br /> MEASUREMENT - - <br /> PERMIT - ;} <br /> REQUIREMENT ' <br /> SAMPLE l <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT i' <br /> SAMPLE <br />E <br />S <br />NT <br />` <br /> M <br />A <br />UREME <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT J <br /> PERMIT r <br /> REQUIREMENT <br /> SAMPLE i <br /> MEASUREMENT - <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE C C O <br />S <br /> MEASUREMENT, V <br />V <br /> PERMIT <br /> REQUIREMENT =' \ <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certify under penall% of law that this document and all suachmenls were <br />e <br />ed <br />de <br />di <br />ectio <br />o <br />e <br />s M <br />i <br />a <br />d <br />e with <br />s <br />t <br />d <br />i <br />d <br />i I TELEPHONE DATE <br /> pr <br />par <br />un <br />r m% <br />r <br />n <br />r wp <br />r <br />on <br />n <br />ccor <br />anc <br />a <br />w <br />em <br />es <br />gne <br /> to aswm that yuallfled peaonnd properl7 gather and evaluate the information <br /> suhmitled. Based on m1 inyuir. of the pcrsam or perwms w ha manage the,) mem. J - <br /> or those person directis responsible for gathering the information, the Information j ` <br /> auhmitled Iv, to ll r hest or m? knnwtedge and belief, true, accurate. and complete. <br />I <br />d <br />h <br />t <br />fi <br />i <br />i <br />f <br />ti <br />h <br />t th <br />i <br />ir <br />f <br />t <br />SIGNATUR OF PRINCIPAL EXECUTIVE <br /> <br />- <br />TYPED OR PRINTED ,- ..re t <br />want pen. <br />,r so <br />rm <br />orma <br />on. <br />a <br />ere are s <br />gn <br />l- <br />tt <br />ng <br />a <br />, <br />n <br />in.Jod m1. the P"s ? ability of fine and ismPti`°nmem (,,I LnowinR`i°1at'n.. <br />" OFFICE OR AUTHORIZED AGENT AREDA NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />EPA Forth 3320-1 (Rev. 3/99) Previous editions may be used. I C ' -• (This' is a d-parf;form.