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PERMITTEE NAME/ADDRESS (include Facility.YamellAcadon if Differenn <br />NAME <br />ADDRESS <br />j X. 628 <br />CO 91424 <br />FACILITY i- lDR I Z ON MINE <br />LocnnoN ,LA CO 81424 <br />LANCE WADE, MINE 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 <br />Form Approved. <br />OMB No. 2040-0004 <br />MNTRS <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ, FREQUENCY SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT is 9ttE R EPC',i r r 4 . <br /> REQUIREMENT JDA G f i1 <br /> SAMPLE - <br /> MEASUREMENT <br /> PERMIT _ REF0RT RE ?F, 1iVC -. <br /> REQUIREMENT 3 UDh1 Fi''v U 1W, i : <br />MU; <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT } <br /> REQUIREMENT i1?? r`tV? <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT )r, ; ?') <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REOUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I crafty under prnalt .d Taw that this document and all attaehmenn weer <br />d TELEPHONE DATE <br /> pre;mrr <br />under - direction or supervision In u cordance with u system designed - _-.- s-- - <br /> to assure that yuahr;ed pervormel properly gather and evaluate the information / <br />_. - - -"- •. _ suhmillcd. Nosed on my inquiry of the per um or persons who manage the system, i <br /> or thow pen,ms di-tiy roponJble for gatheriog The information, the information <br /> whmitted is <br />In the lot of ms knowledge and belief <br />Inte <br />amurute <br />and aun <br />lMe <br /> <br />- - , <br />. <br />, <br />, <br />p <br />. <br />I am aware that them arc stgnlficam penaltin for submittin <br />rake information <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />- / <br />U <br />,r <br />TYPED OR PRINTED , <br />g <br />n.Iuding the Ixrv ibilit, of fine and imprisonment for knowing sbtatlons. OFFICER OR AUTHORIZED AGENT AREA NUMBER <br />CODE YEAR MO DAY <br />AIVII CAYLAtYA b iVN Vr AN <br /> <br />(Reference an attachments here) <br />EPA Form 3320.1 (Rev 3199) Previous editions may be used. 00120 ' _-Tfft8?W4-pa#t, fbi m.