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PERMITTEE NAME/ADDRESS (Include Farilih Name location if iXff ito <br />NAME <br />ADDRESS <br />BOX, 670 <br />DEN CO 8163 <br />FACILITY 'CA MINE COMPLEX <br />LOCATION LIEN co 8163 <br />Y KFRM. REC-LAMATION 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 />MINOR <br />(SUBR JC) <br />F - FINAL <br />DSCHG TO TRIB/SAGE CREI <br />Form A ved. a <br />OMB No040-0004 <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />MEASUREMENT <br />1 <br />(? <br />1 l I <br />?' L, <br /> • <br /> PERMIT <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT - <br /> PERMIT r - ` - <br /> REQUIREMENT <br /> SAMPLE ++ <br />? <br /> MEASUREMENT 1 J { l <br /> PERMIT 1 H I a <br /> REQUIREMENT <br /> SAMPLE <br />R I I <br /> MEASU <br />EMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />M <br />R <br />(4 <br />( <br />V <br /> EASU <br />EMENT <br /> PERMIT _ <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/rlTLE PRINCIPAL EXECUTIVE OFFICER I rrtif) under penaiq oriaw that this document and all atarchmrnty were <br />or u <br />o <br />with a -te <br />r ms di <br />e <br />tio <br />r-ion i <br />a <br />da <br />d <br />si <br />d <br />d <br />l TELEPHONE DATE <br /> praparr <br />urw <br />r <br />r <br />c <br />n <br />W <br />n <br />cc <br />r <br />nce <br />m <br />e <br />gne \ <br /> to a.vurr that qualified personnel properh gather and evaluate the informatim I \ <br /> suhmitled. Rased on my inquin of the penon or perwms who manage the +jslem. rL•Vl <br /> or th- persons dirmtll responsible for gathering the information. the information ' <br />? <br /> suhmined Is <br />M the heA of m <br />knowledge and Mdief <br />true <br />accurate <br />and eomph•te. v '-? <br />1 • <br /> , <br />, <br />, <br />, <br />l <br />11- [- -Moulti <br />inforrootion <br />w <br />, that th <br />a <br />si <br />so <br />t <br />n <br />f <br />l <br />I SI <br />URE OF PRINCIPAL EXECUTIVE .. <br />TYPED OR PRINTED . <br />am a <br />are <br />em <br />re <br />gn <br />an <br />pe <br />., <br />a <br />se <br />ng <br />including the w? vhilit or fine and tmpr -nmvm Mr knowing,inlation.. #FICER <br />OR AUTHORIZED AGENT AREA NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLA IIUN5 (Hererence an anacnmenrs nere) <br />RI <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. <br />EOUEST A REASONABLE POTENTIAL ANANLYSIS <br />0017 " This is a 4-parf-fbmi.