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PERMITTEE NAME/ADDRESS flnclude Faci14 NamdLorafion iJDiffenrtq <br />NAME <br />ADDRESS - -- - <br />670 <br />CC) 19 1637 <br />FACILITY ry VI I NF COMPLEX <br />LOCATION DEN CO 81639 <br />Y KAROr RECLAMATION MANAGER <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPOES) <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 />MINOR OMB No. 2040900040 <br />(SUER `I <br />F -- FINAL RUU <br />DSCHG TO TRIH/HUDDERSON GULCH <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE 1 <br /> MEASUREMENT <br /> PERMIT - _ - •- <br /> REQUIREMENT <br /> SAMPLE ;- <br /> MEASUREMENT ( y <br />t <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 I certify under penallt of law that this document and ail attachment+wxrr <br />d <br />d <br />di <br />ti <br />i <br />i <br />i <br />d <br />h <br />d <br />i <br />d TELEPHONE DATE <br /> on or wpers <br />n accor <br />ance wit <br />a s. stem <br />Prepare <br />un <br />er my <br />rec <br />s <br />on <br />es <br />gne <br /> to --re that qualified Personnel proµ•rl'N gather and esaittate the information <br /> submitted- Based on ml inquiry if the perstm or persons who manage the system. f - , <br /> or th~ person direetl% responsible for gathering the information, the information F <br /> atthmilted is, to the twist of nil knowledge and hi,hef, true, accurate, and c•omplrie. <br />h <br />d <br />i <br />f <br />l <br />i <br />L <br />ti <br />I <br />h <br />i <br />lf <br />b <br />it <br />i <br />f <br />SIGN URE OF PRINCIPAL EXECUTIVE <br />TYPED OR PRINTED rrr, are • <br />n.mt prm <br />es <br />or su <br />se <br />,rma <br />nn, <br />am aware t <br />at t <br />;tn <br />t <br />m <br />t <br />a <br />n <br />ng <br />including di, w-ibilit. --I hoe and impri.onment ror knowing inhdion,- O ICER OR AUTHORIZED AGENT AREA NUMBER <br />D YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIULA I IvNS (rfererence au arracnmenrs nerej <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. 170168: :. j'hjS 6,a ' 4-part fonn.