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PERMITTEE NAME/ADDRESS tInclude F•acilio Namell"ation iJDiJ ffent) <br />NAME <br />ADDRESS „ . ._ t <br />Box 670 <br />HAYDEN r CO 8163 <br />FACILITY ,;EGA MINE COMPLEX <br />LOCATION DEN CO 8163 <br />;Y KARO, RECLAMATION MANAGER <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES) <br />DISCHARGE MONITORING REPORT (D R) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form APPISved a <br />OMB No 2040-0004 <br />MINOR <br />(SUDR jr) <br />F - FINAL ROU <br />DISCHARGE TO SAGE CREEK 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 _ I - <br />C <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE I <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE t i <br /> MEASUREMENT I <br />l _ / <br />_ <br /> PERMIT r. t< ? - - ;,.;• <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT ,,;r? i - ?J <br />- <br /> PERMIT r <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT /y <br /> PERMIT _ <br /> REQUIREMENT <br /> SAMPLE - - <br /> MEASUREMENT i I <br /> PERMIT <br />W REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT { U j <br /> PERMIT <br /> REQUIREMENT h" <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER I certify under penult of law that this document and all attachments were <br />re <br />ared under my direction or su <br />en won in accordance with o s <br />stem desi <br />ned <br /> <br />- <br />TELEPHONE <br />DATE <br /> p <br />p <br />p <br />y <br />g n <br /> to assure that qualified Personnel prnperl? gather and evaluate the information <br /> submitted. Rased no my inquiry of the Perim or persons who muugt the system. <br /> or those persons directly responsible for gathering the inhu"mrtiun, the information es <br /> submitted is, to the beet of ml knowledge and belief. true, accurate, and complete. <br />m <br />w <br />t there are si <br />nificant <br />emdtiey for submittin <br />false informallon <br />I <br />r <br />th <br />SIGNATUR OF PRINCIPAL EXECUTIVE l <br />- <br />- - <br />TYPED OR PRINTED p <br />g <br />. <br />u <br />a <br />a <br />e <br />a <br />g <br />including the possihlllq or rim and imprisonment for knowing ylutatlons OFFICE OR AUTHORIZED AGENT A <br /> <br />REA NUMBER <br />CODE <br /> <br />YEAR <br /> <br />MO <br /> <br />DAY <br />L.VIVIMCIV I J ANN rArLArYA 11VIV Vr A1Y <br />Irlefururic;C all alltly:lllllClliif /IeIe1 <br />REC IP EVENT; TSE <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. 0044;_', 'this is :,t 4-partlf6rnl.