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PERMITTEE NAMEIADDRESS Ilnrlude FacilitT.lame/location if MfjerrnU <br />NAME <br />ADDRESS <br />BOX 670 <br />DEN CD 8163` <br />FACILITY --C;A MINE COMPLEX <br />LOCATION DEN CO 8163` <br />V le AWI ca~rl Am,&-r TrtM I14aPdAn-)=R <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />DISCHARGE MONITORING REPORT (D MR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Appffved• <br />OMB No. 2040-0004 <br />MINOR <br />( UBR JC) <br />F - FINAL <br />DSCHG TO TRIBt6RA55Y CREI <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 /> SAMPLE t '2 1 <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE t <br />f <br /> MEASUREMENT 1 J <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT i --? <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> <br /> MEASUREMENT j <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE i <br /> MEASUREMENT LJ <br /> <br /> PERMIT q r t ^r. ?... i ra <br /> REQUIREMENT i. <br /> SAMPLE <br />t <br />- <br />'1 <br /> MEASUREMENT ') <br />110 <br /> PERMIT <br /> REQUIREMENT `t < 1 ' <br /> SAMPLE <br />i ' <br /> MEASUREMENT I <br /> PERMIT .. <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I /rrlif} wider Imttalq of law that this d-1o1rnt and aI auachmems were <br />aecurda <br />li <br />w <br />i <br />i <br />n i <br />c <br />with <br />s <br />st <br />d <br />si <br />ed <br />d <br />d <br />di TELEPHONE DATE <br /> er my <br />rm <br />on or wl <br />n <br />s <br />o <br />n <br />n <br />r <br />a <br />y <br />em <br />e <br />gn <br />prepare <br />un <br />to assure that qualified pe?nel properly gather and rsaluam the information <br /> suhmimel. hosed on my inquiry of the person ur per m.% who manage the system. 1 <br />/ <br /> or those rwr-n% dir"th respmsible for gathering the information, the information <br /> <br />whmittrd is, a. the best of nq kmw ledge and how, tom, accurate- and complete. <br /> <br />SIGNATU E OF PRINCIPAL EXECUTIVE -' <br />TYPED OR PRINTED 1 ant.. are that them are significant penaltir, for suhmitting false Infntmation. <br />including the IK-iblity of fine and ilnpriwnment for knowing violuliom. OFFI R OR AUTHORIZED AGENT AREA NUMBER YEAR MO DAY <br />%,UIYIMClq 1, AMU CAr'LAPM I IUIY Ur ANT VIULA I IUIVJ (nl:rt:r Cr!/,c aft OlIOtiI I!!!c/rW //c/c/ <br />RECIP EVENT SUBJECT TO BURDEN OF PROOF IN I. A. 3. OIL & <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. T-hi" I,, a 4-pa( "'rill.