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PERMITTEE NAME/ADDRESS Include Fariluy Name/Location if Differearl <br />NAME <br />ADDRESS <br />BOX 670 <br />uEFI •.J C0 8163 <br />FACILITY ECA PINE COMPLEXIWI <br />LOCATION DEN CC1 6163 <br />Y VARO, RECLAMATION MANAGER <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved <br />OMB No. J040-0004. <br />MIr <br />c st <br />F - <br />NOTE: Read Instructions before comDletino 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 <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT . . <br /> SAMPLE <br /> MEASUREMENT ! iJ <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE I <br /> MEASUREMENT 1 <br /> PERMIT , <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT f <br /> PERMIT . <br /> REQUIREMENT <br /> SAMPLE <br />A <br />N i <br /> ME <br />SUREME <br />T <br /> PERMIT r <br /> REQUIREMENT .' <br /> SAMPLE <br /> MEASUREMENT J, ~. <br /> PERMIT - <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I cenifs under prnalt% of Ia% that Ihis d-um•ni and all attachments acre <br />vi <br />d <br />d <br />di <br />i <br />i <br />i <br />d <br />i <br />h TELEPHONE DATE <br /> prrpare <br />un <br />er ms <br />rect <br />on or wper <br />s <br />otl <br />n wcor <br />ancr w <br />a s %Irm designed <br />t <br /> to aswre that qualified perAamrl properly gather and evaluate the information <br /> wbmilted. Rased on m% inquiry or the person or perwas who manage the s) strm• <br /> or thosr pcnsms dirrclly respov sibk for gathering the information, thr information <br /> xuhmitted is <br />W the hest id my knowledge and belief <br />Intr <br />accurate <br />and com <br />lete ` <br /> . <br />. <br />, <br />, <br />p <br />. <br />I am aware that there arr •ignirwam prnalties for submitting falx informntiaa SIGNAT RE OF PRINCIPAL EXECUTIVE <br />TYPED OR PRINTED . <br />inciuding the p-ibilit. 4 ?nv and imprisonment for knowing violutiam? OFFI R OR AUTHORIZED AGENT AREA <br />NUMBER YEAR MO DAY <br /> <br />on oaaos.nuwaaaa raw c/ <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. 0015`L `I'I'lis is a 4-part form.