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PERMITTEE NAMEIADDRESS (Include Fadilly.Yam,11,codion if Dtf/uenf) <br />NAME `;I-,r <br />ADDRESS ' i:JMPLEA <br />BOX 670 <br />'EN CO 8163 <br />FACILITY s?.H MINE COMPLEX <br />LOCATION !-,EN CO 8163 <br />. •!" KARO, RIFCL-AMATION 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.j?040-0004. <br />MINOR <br />( SURF( <br />F - F <br />DSCHG <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> OF <br />TYPE <br /> EX ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE n <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />? <br /> MEASUREMENT ( L <br />" i i <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 <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER 1- 1 fiy under penult) or law that this docunwrit and all attachrnents weir <br />ared <br />re <br />der <br />directio <br />r <br />i <br />d <br />i <br />h <br />i <br />i <br />d <br />l TELEPHONE DATE <br /> p <br />p <br />un <br />nn <br />n o <br />wpen <br />on <br />n aeeor <br />ame w <br />s <br />t <br />a,%%Irm <br />cs gxtet <br /> to a wre that qualified personnel prnperi% gather and es aluatr the inrornmtdon <br />wlrmitted <br />Raerd on m <br />in <br />uin or the <br />s who <br />o <br />v <br />ano <br />th <br />t ? <br />% <br /> . <br />1 <br />penal <br />q <br />r per <br />m <br />m <br />ge <br />e sys <br />em. <br /> or thnst• prnons diretitl% rewponsihlr for gathrring the information. the informatim <br />• <br /> submitted is, 1?, Idtr hest of my kno%ledge and belief, true. accurate, and ;,onplete. I <br />, <br />y <br />1 ?: /?\ <br /> I am aware that tlwm are significant prnaltirs for submitting false inrormauon SIGNA RE OF PRINCIPAL EXECUTIVE <br />TYPED OR PRINTED , <br />including the possibilih of fine and imprisonment for knowing siulutiom, OF CER OR AUTHORIZED AGENT AREA NUMBER YEAR MO DAY <br />I,VMMLpe 10 AI`rV CArLAPrA I IMM Vr /inl <br />Irivierenve an afracnmenfs nere/ <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. C: L hi 1t;' a 4-¢arv fOrnl.