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PERMITTEE NAME/ADDRESS ilnclude Facid7J.Aame/Lorarnon if Different) <br />NAME <br />ADDRESS <br />7 17) <br />vDIFN C..I E31639 <br />FACILITY E C H M t .n COMPLEX <br />LOCATION -E)EN CO 81639 <br />.)Y !A:AR0 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 F- I <br />Form Approved, <br />OMB No.40404004a <br />111 NOR <br />(SUBP JC) <br />F - FINAL ROL <br />DSCHG TO TRIB/HUBBERSON GULCH <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREOUENCY 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 <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 />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER I artd under lxnaiN of law that this document and all atwe.tments were <br />md <br />di <br />ti <br />i <br />ith <br />d <br />d <br />i <br />i <br />d <br />t <br />i <br />d TELEPHONE DATE <br /> pnpu <br />un <br />er m% <br />rec <br />on or wpers <br />on <br />n utor <br />anee w <br />a sys <br />s <br />em <br />es <br />gne <br /> to assort that qualified Personnel property gather and evaluate the information <br /> submitted. Haled on m} inquin of the Person or Persons who manage the c*sstem. <br /> or those persons dimth responsible for gatbering the information. the infnrmatirm <br /> <br />submitted „, to the best of ms knowledge and belief. Irue, an•umte. and complete. II <br />t <br /> I am aware that there are si <br />nirkmm <br />enalties for submittin <br />f <br />lse informatio SIGNA RE OF PRINCIPAL EXECUTIVE <br />TYPED OR PRINTED g <br />P <br />g <br />a <br />n. <br />including the p-ibilit% or nne and imprisonment for knowing violations. OF CER OR AUTHORIZED AGENT AREA <br />DE NUMBER YEAR MO DAY <br />GVMMtrv Ito Arvu CArLAIVA I IVN Ur AIYT VIVLA I IVIVJ Irfererence an affacnmenfs nere/ <br />5PLIED FOR C=I0YR,24HR PRECIP EVEI <br />3ECIP EVENT SUBJECT TO PROOF OF BI <br />Il'a 4-part fAflll. <br />EPA Form 3320.1 (Rev. ng) Previous editions may be used. This