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PERMIITEE NAME/ADDRESS'include Faeilil. A'amel%ocarion it Different' NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS <br />BOX PERMIT NUMBER DISCHARGE NUMBER <br />>cra c_ MONITORING PERIOD <br />FACILITY i::A MINE COMPLEX YEAR MO DAY YEAR MO DAY <br />LOCATION DEN co S I & FROM TO <br />it KARn, RFCI AMATTLZN MANAGI: <br />Form Approved 0 <br />OMB No. 2040.0004 <br />MINOR <br />(SUER JC) <br />F - FINAL RUU <br />DISCHARGE TO SAGE CREEK <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO <br />, <br />FREQUENCY <br />OF <br />SAMPLE <br /> <br />EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT 1- 1 '•I ?t <br /> PERMIT p, <br /> REQUIREMENT : •` ; r%. ;_.: <br /> <br /> SAMPLE <br />; <br />1 ? <br />v <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 /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />I <br />F <br /> REQUIREMENT <br />NAMEn1TLE PRINCIPAL EXECUTIVE OFFICER I a•rtif7 under penalt> of law that this document and all attachments %errc <br />d <br />di <br />ti <br />o <br />si <br />io <br />i <br />a <br />o <br />d <br />with <br />-t <br />m d <br />si <br />n <br />d <br />d <br />s --? TELEPHONE DATE <br /> prepare <br />un <br />er ms <br />rec <br />on <br />r <br />uper <br />s <br />n <br />r <br />ance <br />a <br />e <br />e <br />g <br />e <br />n <br />cc , <br />? <br /> to assure that qualified personnel properly gather and esalunte the infurmathm 1 <br />t <br /> submitted. Based on my inquiry of the person or persons wM' manage the watem, <br /> or those Penurts directi? re+pon-ible for gathering the information. the information <br />1 <br />3 <br /> <br />to the hr+t of me knowledge and belief <br />true <br />accurate <br />and aotnplete <br />s <br />ubmitted h <br />- <br /> . <br />, <br />. <br />, <br />l <br />i <br />ti <br />h <br />h <br />i <br />irk <br />l <br />i <br />f <br />h <br />i <br />ti <br />f <br />I <br />f <br />XECUTIVE <br />SIGN <br />URE <br />OF <br />PRINCIPAL PAL EXECUTIVE <br /> <br />TYPED OR PRINTED an are s <br />orma <br />am aware t <br />at t <br />ani pena <br />t <br />es <br />ur +u <br />m <br />t <br />a <br />se <br />n <br />on. <br />gn <br />ng <br />including the possibility of tine and imprisonment for knowing siolations. OF OFFICER <br />OR <br />AUTHORIZED <br />AGENT AREA <br />DE NUMBER <br />YEAR <br />MO <br />DAY <br />GoMMtNIb A N U tAPLAN AIIUN Ur ANT VIULA11UNJ (rrererence art arlacnments nere/ <br />EPA Form 3320-1 (Rev. T99) Previous editions may be used. () 0 1 `- T is:.h a 4-part f6rm.