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PERMITTEE NAME/ADDRESS (Include F'orilitr A'ante/Gxation if uffereta) <br />NAME JI- ?_ <br />ADDRESS COMPLEX <br />BOX 670 =i <br />UEN CO 8162 <br />FACILITY EC A MINE COMPLEX <br />LOCATION DEN CO 816 <br />Y KAffi177. RIPrI AMA rl i"IN MANA(:FIR <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. aP404)004• <br />)R <br />3R <br />F - FINAL ROUTi <br />DISCNAGI" TO SAGE CREEV. <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 <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />MEASUREMENT <br /> PERMIT <br /> REQUIREMENT t <br /> SAMPLE <br />1 <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />S <br />R W <br /> MEA <br />U <br />EMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAMErr1TLE PRINCIPAL EXECUTIVE OFFICER I certify under pemaln .(I.. that this c]-ment and all atwchmrnt. -re <br />e <br />d u <br />d <br />r m <br />ti <br />Ki <br />d <br />i <br />di <br />i <br />i <br />h <br />d <br />d TELEPHONE DATE <br /> Pr <br />pare <br />n <br />? <br />rec <br />on or supen <br />m <br />n accor <br />ance w <br />a syctetn <br />e <br />t <br />es <br />gne <br /> to assure that qualified pemocnel propedi gather and e.aluatr the information <br /> %uhmiueel. Bard on my inquin of The perwn or pe"wes who manage the ssslrm. <br />or tho+r prr'ams directh re Ixmsible fur gathering thr information. the information <br /> whmilted k. to the best od m) knowledge and belief. true, xcurute. and complete l <br /> I am aware that there arc sigmi k•ant <br />enaltie, for submitting false information SIGNATUq1E OF PRINCIPAL EXECUTIVE <br /> <br />TYPED OR PRINTED p <br />. <br />including the F-ibilin of rim and imprisonment for knowing siodationt <br />OFFIC OR AUTHORIZED AGENT <br />CODA NUMBER <br />YEAR <br />MO <br />DAY <br />UEST A REASONABLE P <br />EPA Form 3320.1 (Rev. 3199) Previous editions may be used. .-' -' t-- ' ' -Ws, is a' 4-part 'foes-n.