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PERMITTEE NAME/ADDRESS anrtade Facility.vamelLocation if mfJerrM! <br />NAME <?` I NG <br />ADDRESS <br />i NVERNIESS LlR i `?F -E, STE 207 <br />EWOUD CO 8011 <br />FACILITY MINE <br />LOCATION -.REEK <br />CO 8446 <br />_Vt LEACH, SR E114V ENGINEER <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />DAY <br />YEAR MO DAY <br />FROM YEAR MO TO <br />Li I <br />Form Approved. <br />OMB No 2040-0004 <br />MINOR <br />(SUBR JC) <br />F - FINAL <br />D,CHO TO KOLL DTCH#3,'TR <br />NOTE: Read Instructions before completinq 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 i <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />I <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />/ <br /> MEASUREMENT ) <br /> PERMIT a :, itF •: , <br /> REQUIREMENT 'iNT (!F: <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT A n`. DAILY '-' Ai •' <br /> SAMPLE <br />MEASUREMENT <br /> PERMIT #'t _ c <br /> REQUIREMENT DAILY N X •j JA <br /> SAMPLE <br />2 <br />G <br />Z <br />C / <br />? <br />C <br />Q <br /> MEASUREMENT " %. SCJ 1 i , <br /> PERMIT a - Fit, <br /> REQUIREMENT r <br />ANNVA <br /> SAMPLE <br />1 < <br />< <br />2 <br />AB <br /> MEASUREMENT y! 1 <br />- <br /> PERMIT <br /> REQUIREMENT <br />NAMElnITLE PRINCIPAL EXECUTIVE OFFICER I eertiQ under penull) of law Chat this document and oll altiichmenls were <br />d <br />d <br />d <br />li <br />i <br />TELEPHONE <br />DATE <br />?? r prepare <br />on or supens <br />un <br />er my <br />irm <br />iwi in mveirdame with a system designed <br />In as urr that qualified peiSonnel properly gather and e.Yluntr the inrormmlm, ._ +•' I ' <br />• <br />" whmilted <br />Rased on my inquire of the <br />er,on or permns who mana <br />e the s <br />stem _- __ <br /> . <br />p <br />g <br />, <br />y i , <br /> or th.ee pe-ot, dirccds "'Ponsihle• for gathering the information, the information i - <br /> whmitted is, to the two of ms knowledge and helief, true. wvurnte, and complete. <br />I am aware that them am s4nlflrA111 prnidlies far snhmiltin <br />false information <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />J.? <br />TYPED OR PRINTED g <br />, <br />including the psssihility of fine and imprisonment for knowing siolations. OFFICER OR AUTHORIZED AGENT AREA NUMBER <br />ODE YEAR MO DAY <br /> <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. 00023/ DrFlltfi ii; a 4-0art -form.