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PERMITTEE NAME/ADDRESS and de, Facility Kamen oratian if u fcrent) <br />NAME CIO, LLi <br />ADDRESS <br />BOX 6=8 <br />:LA CO £31, <br />FACILITY ,4 HORIZON MINE <br />LOCATION LA CO 81, <br />LANCE WADE, MINE MANAQER <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (OMR) <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 />MINOR (SUDR MH) <br />F - FINAL m 4TRS <br />-RX(MTNE DR.NG TRIH Ti 1) R <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. <br /> <br />EX FREQUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />p MEASUREMENT <br /> PERMIT a _ ... P'LPORT PP-l'ORT 7 NCE/ G 1 <br /> REQUIREMENT =?C )A AVG Mx <br /> SAMPLE <br />T ',' MEASUREMENT <br /> PERMIT <br /> REQUIREMENT 1:- <br /> SAMPLE <br /> MEASUREMENT <br />- <br />- <br /> PERMIT 7 77 G R A u <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT k RE'P Oft T REP R <br /> REQUIREMENT I5AT (_.'y <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 />NAMEITITLE PRINCIPAL EXECUTIVE OFFICER I -rtih under penalq of law that Ihu document and ail attachment% were <br />rr <br />arrd under m <br />direriion or %u <br />rr%won in arrurdamr with a •r.tem deni <br />aed TELEPHONE DATE <br /> p <br />p <br />? <br />p <br />g ?- ? - <br /> It, assure that qualified peryonnei pruperl) gather and a%uiuatc the information ? <br />-- ---- <br />--- submitted. Hased on my inquiry or the pe-n or perwn% who manage the stem. ?' <br /> <br />' <br />? <br />or thaw pr-ms directly respumible for gatia-ring the mrurmutiun, the inrormatino -- <br />- <br />- - - - <br />_ , <br /> auhmitted i,. to the best t4 m% knowledge and heliet. trur. accurate. and completr. 1 <br />• ? ? <br /> 1 <br />w <br />th <br />t <br />iti <br />m f <br />b <br />itti <br />i <br />t th <br />i <br />ifi <br />f <br />l <br />( <br />& SIGNATURE OF PRINCIPAL EXECUTIVE ' <br /> <br />TYPED OR PRINTED . am a <br />are <br />gn <br />can <br />pena <br />or w <br />m <br />ng <br />x <br />n <br />orma <br />ut. <br />a <br />ere nre s <br />a <br />a <br />including the possibility ar tine and impriamnant for knowing Notations. <br />OFFICER OR AUTHORIZED AGENT AR <br />CODE NUMBER <br />YEAR <br />I <br />MO <br />DAY <br />COMMENTS AND EXPLANAtIUN VF ANY VIULAIIUNS (Hererence all anacnments nere) <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. 00116 . _nisls 'a 4-0a#i # ern.