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PERMITTEE NAME/ADDRESS tlncladr Faciliq Namel ocaaon if f) frrentl <br />NAME - <br />ADDRESS :- <br />BOX 628 <br />_ <br />LA 4% ' !-'0 81424 <br />FACILITY HOR I Z 11IN MINE <br />LOCATION LA CO 61424 <br />t ANC' F WAnF. M T NE MANAGER <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO F 17 <br />Form Approved. <br />OMB No 2040-0004 <br />MINOR <br />(SUEIR MH ) <br />F - FINAL MNTRS <br />SR&MIINE DRING TRIS TO TUTTLE DR <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />F SAMPLE <br />?r MEASUREMENT <br /> PERMIT I Ci T REP n 1 F'. <br />_ -, REQUIREMENT _'•i DA A"G .AII-.y ~'Y.. <br /> SAMPLE - <br /> MEASUREMENT <br /> PERMIT R P OR I <br />1J fS UJ? REQUIREMENT -..+:... ;??.tiiFi r,'J:; L+F? I i_'r .•! X <br /> SAMPLE <br /> MEASUREMENT <br /> <br />PERMIT <br />K EP R T 71 <br />-, <br />- T. ;: ; REQUIREMENT DF; I L'i. !`1 i01' J <br /> SAMPLE <br /> MEASUREMENT ? !. <br /> PERMIT <br />?T <br />REFOR <br />Ali <br /> REQUIREMENT J Dry I L_ Y 11: - <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 />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER 1 cartify under penalty of law that this document and all attachments were <br />d <br />di <br />i <br />i <br />i <br />d <br />i <br />h <br />d <br />i <br />d <br />- -- TELEPHONE DATE <br /> Preprrr <br />under my <br />rection or supen <br />s <br />on <br />n accor <br />ance w <br />t <br />a system <br />es <br />gne , <br /> to assure that qualified Personnel property gather and evaluate the information <br />` submitted. Based on my inquin of the person or persatt+ who manage the +y+Iem. <br />- <br />-- - - - or those pemau, dimll <br />s resp n%ible far gathering the information, the information <br />Z <br />• <br />I to the best "(my Lnowledee and belief. tax. accurate. and rompMe. <br />+uhmium Is <br />' ` <br />_ . <br />b <br />for <br />w <br />th <br />t th <br />if <br />t <br />ltie <br />fo <br />s <br />itti <br />f <br />ls <br />i <br />atio <br />1 <br />i SIGNATURE OF PRINCIPAL EXECUTIVE - - <br />TYPED OR PRINTED are <br />en arc s <br />gn <br />ican <br />pena <br />s <br />r <br />u <br />m <br />ng <br />a <br />e <br />n <br />m <br />n, <br />am a <br />a <br />Including the possibility of fine um imprisonment for Aaowine ciolutiuns. OFFICER OR AUTHORIZED AGENT AREA NUMBER <br />CODEJ YEAR MO DAY <br />L;UIYIMtrv 15 ANU tAI LAMA I IUN Ur ANT V IULA I IUNJ (riererenve au Arracnments mere) <br /> <br />EPA Form 3320-1 (Rev. 3,199) Previous editions may be used. 00156, JhiQ"'4Pact f0rni.