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PERMITTEE NAME/ADDRESS Unlade Fariliry Namelloration if lli)Jerentl <br />NAME <br />ADDRESS NO. 2 MINE <br />CO 8142E <br />FACILITY AE <br />LOCATION C-0 8 1 4 2 E <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 />(SL <br />F - <br />Sf? <br />Form Approved. <br />OMB No. 2040-0004 <br />HU13, <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREOUENCY <br /> <br />OF <br />SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <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 s <br /> REQUIREMENT - <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I crrttf> under penalt) of law that this d--anent and all attarhments were TELEPHONE DATE <br />prepared under m) direction or wpersision in accordance with a system designed <br />to assure Otani qualified personnet proprd'% gather and esaluate the inrurrnation <br />submit". Based on ms inquiry of the person or p-nas who n ousi a the srstem. <br />or tho,r per,-direct1% responsihte for gathering the information. the informall" <br />.uhmittc i is, to the ht A or ms knowhdge and belief. true, ncrurate, and complete. SIGNATURE OF PRINCIPAL EXECUTIVE - -- <br /> 1 am nwam that there are signiravnt penalties for submitting false information. <br />ossibilit <br />of f <br />d im <br />riwmtnrnl for knowin <br />sirdatinm <br />d <br />di <br />the <br />e <br />i OR AUTHORIZED AGENT <br />OFFICER AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br />TYPED OR PRINTED g <br />, <br />m <br />u <br />p <br />y <br />in <br />an <br />p <br />ng <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />.1P EVEhJ i I,t CLAIMED. IF CLAIM APPROVED BY WOO <br />:-NTS-SEE I. A 3, PG. 4-5 FOR BORDEN OF PROOF' <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. _ This-is a 4-part form.