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PERMtTTEE NAME/ADDRESS Flncfadr Facifitx AamdLocation if Differoat <br />NAME <br />ADDRESS _ -ji'., -.l. <br />BOX" x170 <br />:EN CO 61639 <br />FACILITY LCA i"INE COMPLEX <br />LOCATION DI.N CO 61639 <br />r KARO, RFCL_AMATION MANAGER <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />I <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />FROM YEAR MO DAY TO YEAR MO DAY <br />Form Approved. <br />OMB No. W40,0004* <br />M I NOR <br />(SUBP ; <br />F - FINAL ROUii <br />DSCHQ TO TRIB/HUSBER50N GULCH <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION Np, FREQUENCY SAMPLE <br /> <br />>< EX OF TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> <br />SAMPLE <br />/ <br />? ......................... ... .. <br /> MEASUREMENT Lj ,, Lj u I IrL?, <br /> PERMIT ?- ; <br /> REQUIREMENT f?1A X Y ! <br /> SAMPLE "` r <br /> MEASUREMENT { <br />i, <br /> PERMIT <br /> REQUIREMENT Y" <br /> SAMPLE <br /> MEASUREMENT 1 <br /> PERMIT :~ r'•1.: <br /> REQUIREMENT :3L.,i-. + <br /> SAMPLE r <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />MEAS <br />REMENT <br /> U <br /> PERMIT = ,r <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE ; <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certify under penult% or law that Ihts document and all attachments were <br />prepared under m% direction or supenision in accordance with a system designed TELEPHONE DATE <br /> to assure that qualified personnel properli gather and evaluate the information <br /> submitted. Based on m.s inquin of the perwn or persons who manage the ystem, <br /> or thou penlms dir-14 mponsible for gathering the information. the information <br /> submitted is, to the best of my knowledge and belief, true, accurate, and complete. <br />I am aware that there are %ignificanl prnaltih for submRting false infowmation <br />SIGNA RE OF PRINCIPAL EXECUTIVE <br />i "y- <br />TYPED OR PRINTED , <br />including the possibility of fine and imprhonmeat for knowing OFF ER OR AUTHORIZED AGENT AREA NUMBER <br />CODE YEAR MO DAY <br />MI9N CArLM1'1M 1IVln yr Mint <br />II'7al Ofallt:a all aitatilli/ferric`f /Ialal <br />EPA Form 3320.1 (Rev. 3199) Previous editions may be used. _ .. This is a 4-part form.