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PERMITTEE NAME ADDRESS <br />NAME <br />ADDRESS MINE <br />HO''' 628 <br />-A CO 8!424 <br />FACILITY HOR i Z0N M 114E <br />LOCATION :_A CC 81424 <br />i Atjrtr ucknF. tMSA11= MAtJArZ1=R <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) Form Approved. <br />DISCHARGE MONITORING REPORT (DMR) OMB No. 2040.OON <br />i' . H . <br />PERMIT NUMBER DISCHARGE NUMBER F 1 NAL MNTRS <br />MONITORING PERIOD WET TESTING FOR 010A <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, Of FREQUENCY SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE - - <br />r; MEASUREMENT <br /> PERMIT ! + ?# u tr?l 00. 0QC)1 r ###### Fc- C "1 <br /> REQUIREMENT - !`IN VALUI ' ANNL`" <br /> <br /> SAMPLE ( Q ; <br />F; MEASUREMENT <br />F PERMIT tEi r.i## # iii- ?00. 04)01 Sim Estir #tt##iY# i - 'k+ <br />r' REQUIREMENT rf#s NN VAL`•_tE ANNLA - <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 t certrf) end:, p,r:.dp It taw that this document and all attachments were TELEPHONE DATE <br /> Prepared iv,:-, in) direction or supervision in accordance with a system designed _ <br /> to aaaure th.o tu difit•d personnel propcriy gather and evaluate the information <br /> submitted Baecd on my inquiry of the person or persons who manage the eystcm, <br />- or those persons directly responsible for gathering the information, the information <br /> submitted is. to.the best of my knowledge and belief, true, accurate, and complete <br />i <br />i <br />fal <br />i <br />t <br />- <br />i <br />if <br />l <br />f <br />b <br />i SIGNATURE OF PRINCIPAL EXECUTIVE ? •• -?, 1 '1 _ <br /> <br />TYPED OR PRINTS are s <br />gn <br />icant pena <br />ur su <br />m <br />ng <br />se <br />n <br />ormanon. <br />lam aware that the; <br />t <br />es <br />tt <br />l <br />f f <br />i <br />f <br />k <br />i OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br /> nowing %io <br />at <br />oas <br />including the posstbilty o <br />ine and rmpr <br />sonmem <br />or CODE <br />.. -onO1IQ ANLI CAYLAIYAI IVN Vr AF-4T VIVLAI IVIV, (Hererence an artacnrnenrs here) <br />-EPORi LOWEST DII <br />I C T_ i 'r TEST REPOI <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. <br />ENT) WHICH IS <br />1 his is a 4-part trr:u