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PERMITTEE NAME/ADDRESS (lnrludr F'ardirr NamelLararioa if biffereuq <br />NAME <br />ADDRESS <br />LOX 670 <br />GEN ;:Q 81639 <br />FACILITY :7C A M I NE COMPLEX <br />LOCATION BEN CO 81639 <br />KARO, RECLAMATION MANAGER <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES) <br />DISCHARGE MONITORING REPORT (O R) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Awr. - .y?,, <br />OMB No. 2C --?'i <br />(SUDR JC) <br />F - FINAL ROU <br />-"rt-If` Tn -RT9/i3RArSY (-R'=FA <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT •J / y <br /> PERMIT - r, <br /> REQUIREMENT ; I_ <br /> SAMPLE <br />M <br /> EASUREMENT <br /> PERMIT P.- r j r-, i <br /> REQUIREMENT C: L. ; X <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT r. r .. f, <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT ` <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />ME <br />S <br /> A <br />UREMENT <br /> PERMIT 1-7 l" <br /> REQUIREMENT <br /> SAMPLE <br />M <br />AS <br />R <br />? <br />J ;- <br />=> <br /> E <br />U <br />EMENT - -- - <br /> PERMIT i . ! <br /> REQUIREMENT C •=. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT t :_y r t' _ ! <br /> REQUIREMENT '.'' <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I cerlih undrr pcnulq ad law Ihut this drrumcot anal all attnchmrnh were <br />prrp,r d under nn direction or sap--ion in aevordunce with a s <br />stem designed 1 TELEPHONE DATE <br /> y <br />ba:nvure that qualified penannel properh gather and evaluate the inkrrmation , <br /> whmitted. Navrd on my inquirt of the penon or pervnnv who manage the y.tem, i <br />r <br /> or tho+e Wmmv directly ra prmcible for gathering the information. the information :• <br /> submitted i., to the best of my krwwledge and belief, true. uccuntr, and rompirtr. <br />I am aware that there un si <br />nifio <br />ml <br />enaltir5 row whmitting fahe• inG,rmalion SIGNAT RE OF PRINCIPAL EXECUTIVE I ? ? <br /> <br />TYPED OR PRINTED g <br />p <br />. <br />. <br />including the po..lbibr. ?.( fnr :and impriv mncnt for knowing aiol:,uon.. <br />OFF ER OR AUTHORIZED AGENT AREA <br />CODE NUMBER <br />YEAR <br />MO <br />DAY <br />COMMEN 15 ANU tAYLANA I lUN Uh AN T VIULA I TUNS (HererenCe all attachments here) <br />1IRED TO REQUEST 'A REASONABLE POTENTIAL ANALYSIS BE <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. 000 11 "This is a 4-pant f6mi.