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PERMIITEE NAME/ADDRESS Include Farilgy Namr/loration ijUi,Q'erent) NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS <br />PERMIT NUMBER DISCHARGE NUMBER <br />FACILITY MONITORING PERIOD <br />i-.C A t ! ;•4Z C tJP"r' `c X YEAR MO DAY YEAR I MO DAY <br />LOCATION DEN Co slf FROM TO <br />Y KARO, RECLAMATION MANAGE <br />Form Approved. <br />OMB No.8040.OD04t? <br />MIN <br />(SU <br />F - <br />CHR <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. <br /> <br />EX FREQUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT 4GSHi `i- <br /> <br /> SAMPLE r <br /> f: is <br /> MEASUREMENT 1 <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 : Y. ; . <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT s.. . t' . : . <br /> REQUIREMENT <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER l aertir. unda•r ixnalt? nrlow that thi. d w'unrrnt amt all .dlachmrMs were <br />re <br />ared under nn dirretion or s <br />wr%ision in areordance with A <br />mrm desi <br />ned TELEPHONE DATE <br /> p <br />p <br />r <br />% <br />g <br /> lu as nm that qualified p-nnel prnperly gather and evaluate the information <br /> submitted. Based on my irpuin rd the person ur pe-n% who manage the svstem. <br />t <br /> nr Ih.ne persons direrU\ respmsibir for gathering the infivemaiiim. the Infmrmolinn - <br /> <br />submitted I%. Ito the hest of m'o kri-Wgr and brlkr. trite. accurnie. and complete. <br />1 am aware that there are st <br />nirw <br />r <br />t <br />lti <br />s fo <br />h <br />itti <br />r <br />l <br />i <br />fr <br />atio <br />SIGNATU OF PRINCIPAL EXECUTIVE 1 <br />= <br /> <br />TYPED OR PRINTED g <br />a <br />t <br />pena <br />e <br />r w <br />m <br />ng <br />a <br />x <br />n <br />rm <br />n. <br />im-luding the gnsihdit? or rim and impris ment for knowing violations. <br />OFFIC OR AUTHORIZED AGENT AREA <br />DE NUMBER <br />YEAR <br />MO <br />DAY <br />1•:UMMtN I Z) ANU t:A VLANA I IUN Ur AN T <br />Irreverence au arracnmenrs nere) <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. This IS H 4-part form.