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PERMITTEE NAMEIADDRESS (Include F"iGp \'amelLocation if Different) <br />NAME <br />ADDRESS <br />BOX 670 <br />DEN - r: U 8163 <br />FACILITY ECA MINE CCIMP; .-EX <br />LOCATION 'DEN CO 81.63 <br />..e re -Hart cn Cf-r AMA r rr'IIN MAk1AhtCi? <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 L_ I I' <br />Forn Approved <br />OME No 4401CCC - <br />MINOR <br />(SUBR JC <br />F - FINAL <br />DISCHARGI <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ, FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE r <br />77, <br /> MEASUREMENT i ' <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />? <br /> MEASUREMENT l <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE 1 <br />y <br /> MEASUREMENT J <br /> PERMIT _ . ,_ . . <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I crrtif> under permits or lax [hut this draument until all attachment. wire <br />pre <br />ared under my dimclitm or wprrsision in accordance with u system drsigned <br />- TELEPHONE DATE <br /> p <br />o" -urr that qualifW perwnnel properly gather and evaluate the information - ` <br /> whmiuerl. Rued on my inquiry of the person or prrvms who manage the system, T ., f? <br /> or thrw? prnons directh rmix,n bk for gathering the information, the information <br /> whmitted i., .,he 1>r l of my kn-ledge and holier, true, accurate. and complete. <br /> <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />- <br />j <br />TYPED OR PRINTED <br />I I am aware that there are significant penalties for submining falw information, <br />Including the M sitelity rd rme and imprisonmrni for knowing •iUlatioM. OFFICER OR AUTHORIZED AGENT AREA NUMEIER <br />CODE YEAR MO DAY <br />UVMMtNIb ANU tAVLANAllUN yr ANT VIVLAIIVFV0 (PIVICfullcC Ulf AtIOt III /ICIIID'out=/ <br />ED TO REQUEST A REASONABLE POTENTIAL ANALYS19 III <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. 00204 This is a 4-part ?fonn.