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PERMI TEE NAME/ADDRESS 11nrfude Facility Naadbnratiun if DtfferenU <br />NAME <br />ADDRESS <br />'' ?=S 1 b3' <br />FACILITY E A M11-4E COMPLEX <br />LOCATION DEN CO 1163' <br />`Y K.ARO, RECLAMATION 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 Appaved a <br />OMB No. 2040-0004 <br />I) I <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />v <br /> MEASUREMENT % J <br /> PERMIT _ <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT i * # <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 <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAMErnTLE PRINCIPAL EXECUTIVE OFFICER I cenir% tinder prmalp of law that this deeumens and all attachments were <br />prepared under nn direction or wpenidon in accordance with u -Mrm drsigned TELEPHONE DATE <br /> to assure thus qualified pemonnel properh gusher and evaluate the infonnaiiim <br /> submitted. Nawcl on m? inquire of the penon or peram% who manage the stem. <br /> or th- prnums direcils respmsibk for gatherinR the information, the information 7 <br /> whmitted is, to the, bet of - Anow1ed!V 4nd belief. tnte, accurate and rompkte. <br />I am aware that there are significant <br />w-f ie? for uhm fittin <br />rape inrurmntion SIGNAT RE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED OR PRINTED j <br />g <br />. <br />including the rassibilih of fine and impri-no tit f..r knowing eiotulion, OFFI{1 ,ER OR AUTHORIZED AGENT AREA <br />ODE NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />QUEST A REASONABLE POTENTIAL ANALYSIS <br />EPA Form 332G-1 (Rev. 3/99) Previous edftions may be used. i (.. TNis.C5 4 4-pa- f;f6m).