Laserfiche WebLink
PERMITTEE NAME/ADDRESS ,include F'ariGtr.4amellncation if Different) <br />NAME <br />ADDRESS <br />iEN GU 81631i <br />FACILITY a C A MINE COMPL.EX <br />LOCATION I)EN CO 8163 <br />Y KARD, RECLAMATION MANAGER <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />FROM YEAR MO DAY TO YEAR MO DAY <br />Form Appfpved. a <br />OMB No 2040-0004 <br />NOTE: Read Instructions before completinq this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY SAMPLE <br /> OF <br />TYPE <br /> EX ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />r. <br />i <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE I <br /> MEASUREMENT <br /> PERMIT I <br /> REQUIREMENT <br /> SAMPLE - 7 <br /> MEASUREMENT I <br />1• <br /> PERMIT rc it f - <br /> REQUIREMENT <br /> SAMPLE r <br /> II 1 <br /> MEASUREMENT • l ? <br /> PERMIT < <br /> REQUIREMENT UA 1!. Y <br /> SAMPLE <br />...-. c?; MEASUREMENT L o <br /> PERMIT - - F _, <br /> REQUIREMENT <br /> SAMPLE I <br /> ( <br /> MEASUREMENT <br /> PERMIT , <br /> REQUIREMENT _ ,'.• <br /> SAMPLE <br />MEASUREMENT <br /> <br /> PERMIT i r ..t.. t <br /> REQUIREMENT - <br />NAMEITITLE PRINCIPAL EXECUTIVE OFFICER I cerlih under penulq of law that this document and all attachment. were <br />d <br />d <br />di <br />i <br />TELEPHONE <br />DATE <br /> prepare <br />un <br />er m> <br />rect <br />on or supersisiun in accordance with a system designed ` <br /> to -sure that qualiried personnel pnperls gather and esaluale the information <br /> submitted. Hand on my inquire of the penon or perwro who manage the system. <br />or those persons directly responsible for gathering the information. the infornuIlion <br /> <br />'"" submittedd h, to the best of t. knowledge and belie(, truce accurate, and complete. <br />I am aware that there arc si <br />nificant <br />enalties for .uhmittio <br />tofu inf <br />m <br />tion <br /> <br />SIGNAT RE OF PRINCIPAL EXECUTIVE J lJ <br />TYPED OR PRINTED p <br />g <br />g <br />or <br />a <br />, <br />including the pxo,sihilits of fine and imprisonment for knowing skdations. OFF ER OR AUTHORIZED AGENT AREA NUMBER YEAR MO DAY <br />VWnnretcll IQ Algv r-ArLMI`rn I IWIV yr rats T V I%JL- M I rvtv0 (rrenrrence ate airacnmenis nere) <br />'RF!? TO RFIII-1F"T A REASrINABLE POTr-NTTAI. ANAI-YST`? r'F <br />EPA. Form 3320-I (Rev. 3199) Previous editions may be used. ni%ti-IS a 4-oars-form. PAGE OF