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PERMITTEE NAME/ADDRESS Unclude FadGfr %ameflocation if Different) <br />NAME <br />ADDRESS (. L;; i'r .- .: <br />BOX 670 <br />DEN CO 5163 <br />FACILITY •r;;A MINE COMPLEX <br />LOCATION DaN CO' 9163 <br />:Y KARO, RECLAMATION MANAGER <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES) <br />DISCHARGE MONITORING REPORT (D R) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MID DAY <br />FROM TO <br />Form Approved. <br />OMB No. 040-00D n <br />N I NOR <br />(SUEIR JC <br />F -- FINAL Ruki <br />DSCHG TO IRIS/DRY CREEK <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> EX OF TYPE <br /> ANALY <br />SIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT L <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE 7 - <br /> MEASUREMENT <br /> <br /> <br />PERMIT 'I' T <br />' f' '" <br />` <br /> <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />4, 1 r-,i_.: i _. MEASUREMENT <br />n PERMIT t: . <br /> REQUIREMENT <br /> SAMPLE <br />I <br /> MEASUREMENT <br /> PERMIT - <br /> REQUIREMENT r I <br /> SAMPLE <br /> <br />M <br />S <br />R <br />ENT I ? t <br /> EA <br />U <br />EM <br /> PERMIT .-. I <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I -rtif% itmirr penally u( lam that ahisdtrunenl and all attachment. were <br />der m <br />dc <br />tio <br />o <br />ision i <br />ord <br />rrd u <br />. <br />a <br />with <br />t <br />d <br />i <br />d TELEPHONE DATE <br /> prepa <br />n <br />y <br />nr <br />n <br />r <br />upen <br />n <br />cc <br />ance <br />a sys <br />em <br />es <br />gne <br /> to aswrr that qualcritd perKnnnei properlc gather and evacuate the information <br /> wbmilttd. Ita+cd on m? inquiry of the per,on or persons mho manage the system. <br />- <br /> or Ihost• per,,- directiy rcvpo" <br />hk fur gathering the informuniat. the information <br /> submitted iv. to the t •al of my knomtedge and twhef, tnte. accurate, and romp(de. f <br /> I am amart• that there are si <br />enalties for uhminin <br />nificant <br />faiw information SIGN TURE OF PRINCIPAL EXECUTIVE - U <br />TYPED OR PRINTED P <br />g <br />, <br />g <br />including Iht•I , w vetibtv of finr and imnn<,mmrnt for km,ming tI,rlotions. OFFICER OR AUTHORIZED AGENT A <br />CODE REA NUMBER <br />YEAR <br />MO <br />DAY <br />AI`ILJ CAM.MNMIIVI`I Vr mriT V1VlNImil-la Ir7e1ere/ILe Hit 6IIdGnlnenl5 here) <br />NABLE POTENTIAL ANALYST <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be Used. `-Mis iS'a 4-part brM.