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PERMITTEE NAME/ADDRESS,lncludr Facdlq Namellucmion if Uifferentl <br />NAME <br />ADDRESS i- x <br />Lj P: <br />DEN n ; &'35 <br />FACILITY ' ECA MINE <br />C Q,"P t: <br />LOCATION Dt'N l: S 1 635 <br />KAPrl ZFC:I AMATTnN MANA(,FR <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />FROM YEAR MO DAY TO YEAR MO DAY <br />Form Approved. <br />OMB No.,?040-0004s <br />MINOR <br />(SUER 0C) <br />F - FINAL RLW <br />DSCHID TO TRIB/DRY CREEK <br />NOTE: Read Instructions before comoletino this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> EX OF TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT 1 <br /> <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 />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I -'if, under prnuln of la„ [tint this document and all attachment% were <br />d <br />d <br />di <br />ti <br />i <br />i <br />d <br />i <br />TELEPHONE <br />DATE <br /> a <br />prepare <br />un <br />er m% <br />on or aLpen <br />on <br />n accor <br />ance with o stem designed <br />rec <br /> to assure that qualified personnel properly gather and evaluate the information <br /> submitted. Based on my inquiri of the person or perssass who manage the system. <br /> or those person% dirtctis responsibir for gathering the information. the information <br /> submitted is. to the beat of mN knowledge and belief, true. accurate, and complete. <br />I am aware that there are significant penalties for submitting false information SIGNATUfaE OF PRINCIPAL EXECUTIVE 1 <br /> <br />TYPED OR PRINTED . <br />including the possibility of Ent and imprisonment for knowing vlolatimm. <br />OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br />y.vrnm?o• r u nnv ?nrl-,snn r wrv vr- M1,11 vrvL-,a r nvnQ lnararenr.o all <br />auacrnnarna rror e/ <br />[ OYR, 24HR PREC I P WENT SUBJECT OF <br />EPA Form 3320-1 (Rev- 3199) Previous editions may be used. ; Then is a 4-patt`f6rm.