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I PERMITTEE NAME/ADDRESS !include PaciArj ,4'amellocatiun if llhf'ereur) <br />NAME .;ULI_ii= ADJrJ <br />ADDRESS =W HORIZON MINE <br />0. BOX 628 <br />'(-LA Co 81 <br />FACILITY HORIZON MINE <br />LOCATION A CO 81 <br />LANCE WAIF=. 11T A3F MANI46(;-I R <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 />OMB No. 2040-0004 <br />"IN' I RE <br />NOTE: Read Instructions hpfnrp rmmnlptinn 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 REPORT <br /> <br /> REQUIREMENT <br />rtV <br />.-LILY r A <br /> SAMPLE _ <br /> MEASUREMENT <br /> PERMIT <br />ri T <br />r; <br /> REQUIREMENT WG N .X <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT :..• it RERMT <br /> REQUIREMENT i; A T I.. Y Mx <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 />NAMErrITLE PRINCIPAL EXECUTIVE OFFICER I certir> under penalty.( law that Ihh dacuannt and all attachments were <br />d <br />i TELEPHONE DATE <br /> prepare <br />under mi d <br />rection or sulenirion in accordance with a %Nmem designed <br /> <br />- t,• assure that qualified pervonaei pmperl.% gather and eyahute the information <br /> uhmilled. Based on my inquin of me person or person% who manage the ststem. <br />or th- pecan dimctby responsible for gathering the information, the Information -, <br />- <br />' • • whmitied i.. to the bext of m% know ledge and belief, true, accurate. and complete. <br />1 am aware that th <br />re <br />re si <br />ifi <br />t <br />e <br />r <br />lU <br />b <br />it <br />i <br />f <br />l <br />i <br />f <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />TYPED OR PRINTED <br />/`AaIaIC\iTn ...n r..... .... ?..... ..? ..... e.ei.. e <br />a <br />gn <br />can <br />p <br />ia <br />oe su <br />n <br />m <br />t <br />ng <br />a <br />w <br />n <br />onration, <br />iniuding the p.cibilily orrme and imprisonment for km.wing stodations. <br />arm..... .a._e____-" _.. -.. OFFICER OR AUTHORIZED AGENT CODA NUMBER YEAR MO DAY <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be Used. OO 1 qO / Crhii 33i, 4'oat`ibrm.