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PERMITTEE NAMEIADDRESS (include Facky .Name/location iJlhfjerent) <br />NAME <br />ADDRESS <br />GUX _'3 <br />'_A C:O H1A <br />FACILITY HOR t Zi]N M { P4E <br />LOCATION A co 81A <br />LANCE WADE, MINF- MANIAGER <br />NATICNAL 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 />Forth Approved <br />OMB No 2040-0004 <br />JTR5 <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT t"iA.k <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 /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER I ceruf% under penalt% of law that this document and all attachments were TELEPHONE DATE <br />prepared under m. direction or supcnislon in accordance with a system designed - <br />to assure that qualified personnel properly gather and c%aluale the information <br />"-"- - submitted. Based on m> Inquin or the prison or persom who manage the s),tem. <br />- - " or those penuns directly mponcible ror gathering the information. the Information <br />- <br />1 <br />J - submitted is, to the hest of my knowledge and holier, true, accurate, and complete. <br />SIGNATURE OF PRINCIPAL EXECUTIVE - - <br /> I am aware that there are signirkant penalties ror submitting false infurmarkm. AREA <br />I <br />ED ~tssihiliq nd rme amt imp' rn°nmrnt for knowing iufatioas <br />includin <br />the OFFICER OR AUTHORIZED AGENT NUMBER <br />E YEAR MO DAY <br />NT <br />TYPED OR PR . <br />g <br />s D <br />COMMLN 15 ANU LAF'LANA I IUN Ur Ar4 T VIULA I IUt,40 (r7erwrtrtmov rrtr auacroncnw rrcrc/ <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. This i&'a"4-pa>"vf6nn.