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PERMITTEE NAMEIADDRESS Nncfade FariGq Name/l.uration if Di ferenti <br />NAME <br />ADDRESS <br />BOX <br />'-BEN CO 8163 <br />FACILITY ;_CA MIN'E COMPLEX <br />LOCATION U-Efv GO $163 <br />Y K.ARO, 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 MO DAY <br />FROM TO <br />Form Approved. <br />rhINoy OMB No. X040-0004A <br />(SUER JC) <br />F - FINAL ROU' <br />1?SCHG TO 'TR I D /SAGE CREEK <br />NOTE: Read Instructions before comoletina this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY SAMPLE <br /> OF <br /> EX ANALYSIS TYPE <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 do <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT r. e li•, <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT i .. <br /> REQUIREMENT ;- <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT f'%a rF 7 <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT I F <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certif, under peaaltl of law that this document and all atWohmenl%weer TELEPHONE DATE <br /> prepand untler m% direction ur supervision In accordance with a system designrd <br /> to assure that qualified personnel properly gather and evaluate the information <br /> submitted. Rased on my inquire of the person or persons who manage the -tern, ` <br /> or thine person directly rest imihle for gathering the information. the iarnrnmthm 41 <br /> submitted is, to the best or m% knowledge and belief, true, accurate, and complete. <br /> I am aware that there are si <br />nifirr <br />i <br />ultic: f <br />r <br />bmitti <br />f <br />l <br />i <br />f <br />d SIGN TORE OF PRINCIPAL EXECUTIVE ' <br />TYPED OR PRINTED g <br />n <br />pen <br />u <br />su <br />ng <br />urma <br />a <br />se <br />n <br />on. <br />including the Iwnsihility of rine and imprisonment for knowing violations. OF ICER OR AUTHORIZED AGENT AREA NUMBER YEAR MO DAY <br />. ,.....?..?.. ..... ?........?.,... ,.? ........,.. ._. .._ ._ OD <br /> <br /> <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. ]0396 i -,Ttiisihi a 4-pats form.