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PERMITTEE NAME/ADDRESS (Include Facinty.Yame/Loeation if Different) <br />NAME <br />ADDRESS '--.CA MINE <br />BOX 670 <br />_EN CO 6163 <br />FACILITY CA !IV-4E COMPLEX <br />LOCATION EN ca B163 <br />1 'KARO. RECLAMAT ION MANAGER <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />I I <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form ApWved. is <br />OMB No. 2040-0004 <br />**A <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 /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE i <br /> MEASUREMENT I <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE i <br />I c <br /> MEASUREMENT . I ?r y <br /> PERMIT F - <br /> REQUIREMENT <br /> SAMPLE <br />` <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />MEASUREMENT <br />'/ <br />l <br /> - I <br /> PERMIT t - <br /> REQUIREMENT I <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certifs under penalty rdluw that this document and All attachments Wert <br />prepared under m) dinvtion or suprrsiskn in xtordance with a % <br />stem desi <br />ned TELEPHONE DATE <br /> ) <br />g <br />to assure that qualified personnel property ttalher and esaluutr the information n <br />- <br /> submitted. Based on mY inquin of the person or prrsons who mange the %i%lem. / <br /> <br />or Ihow- prrsom dirx9ls respon%ibk for gathering the information. the informal." ? <br /> suhmitt d is, to the best of m% hnowbdge and brbef. true. accurate. and compktr. <br />I am aware that there ears si <br />nificant <br />enultim for suhmiuin <br />false information <br />SIGNATURE O PRINCIPAL EXECUTIVE <br />TYPED OR PRINTED p <br />g <br />g <br />. <br />including the pnssibilin of fine and imprisonment for knowing %iolations. OFFICER O AUTHORIZED AGENT AREDA NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference aff attachments here) <br />PAGE OF <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. Th1slti 8 4-p&Tt font.