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PERMITTEE NAME/ADDRESS Ilnrludar Faruirf :Vame/f.,watinu if Uif/enntl <br />NAME C <br />ADDRESS <br />BOX 628 <br />LA CO 514 <br />FACILITY HORIZON MINE i <br />LOCATION O 814 <br />LANCE WADE, MINE MANAGER <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES) <br />DISCHARGE MONITORING REPORT (D R) <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 />MH) <br />NTERIM <br />N?= T)RI= TO CAL -A <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO <br />. FREOUENCY <br />SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />. . REQUIREMENT I I I", MAX 1 MIA. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT a ; .: .. <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT } <br /> REQUIREMENT <br /> SAMPLE <br />?. •-' t i `' MEASUREMENT <br /> PERMIT - <br /> REQUIREMENT fir ti • ` `Il:r i I l._ ; ' = <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />MEASUREMENT <br /> PERMIT s . - . - <br /> REQUIREMENT <br />NAMENITLE PRINCIPAL EXECUTIVE OFFICER I cernf% under penalty of law that chi%doeument and all attachments were <br />i <br />ith <br />t <br />d <br />d <br />di <br />li <br />i <br />i <br />d <br />d <br />i <br />d TELEPHONE DATE <br /> un <br />er my <br />on or superv <br />n atcor <br />ame w <br />u sys <br />em <br />gne <br />prepure <br />rm <br />s <br />on <br />es <br /> to as>ure that quallrled personnel properly gather and es aluate the information I <br /> suhmilted. Board on m? inquiry or the person or persons who manage the system. <br />-: - <br /> or those pawns dirn•th responsible for gathering the information. the information _ <br /> suhmitted K. to the brst of m% knowledge and belief. true, accurate. and aanplete. ) } <br /> w <br />1 <br />th <br />t th <br />v <br />ig <br />t <br />lti <br />r <br />b <br />i <br />ti <br />f <br />i <br />i <br />f <br />i SIGNATURE OF PRINCIPAL EXECUTIVE - <br /> <br />TYPED OR PRINTED are <br />ere are <br />crn <br />pena <br />oe su <br />m <br />ng <br />n <br />ormat <br />on, <br />am a <br />a <br />es <br />t <br />a <br />a <br />gn <br />insiudlag the pusdbiliq of fine and impriwnmcni fur krwwiag vioiaeions. OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />CODE <br />YEAR <br />MO <br />DAY <br />GUMMr-N1D AIVU r-AVLANAIIUN Ur ANT VIULAIIUIVA (rfererence an <br />nere/ <br />-MIT' APPLI'ED' FOR IOYR, 24HR PRECIP EVENT - SEE I <br />,rrTnntc-- _ T r 1n. va 7lZ qn nAV AVa Tq HTaHFST MfIP <br />EPA Form 3320.1 (Rev. 3%) Previous editions may be used. 1d26'' °I7uS4s 8' 4-pat Tf)Tm.