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PERMITTEE NAME/ADDRESS (Include Facility A'amell neanan if lbJ/aen1) <br />NAME <br />ADDRESS <br />BOX 670 <br />_DBN CO 81639 <br />FACILITY -L'A MINE COMPLEX <br />LOCATION BEN CO E31639 <br />Y KARO, RECI,AMAT I ON MANAGER <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPOES) <br />DISCHARGE MONITORING REPORT (D R) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />FROM YEAR MO DAY TO YEAR MO DAY <br />Form ApRfpved. 0 <br />OMB No. 20aa0004 <br />MINOR <br />.i <br />(SUBR JC ) <br />F - FINAL ROUTT <br />GNRONIG TEST FOR <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREOUENCY SAMPLE <br /> EX F <br />O <br />TYPE <br /> SIS <br />ANALY <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT t .- <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 /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER I remits under woah, if Iaw Itlat Ihi, does, risen I and all atla,bminls wen <br />direr lion or cu <br />r.kio <br />e with <br />e <br />a <br />ed <br />d <br />i <br />wa <br />o <br />d <br />c <br />at <br />desi <br />ed <br />'•? TELEPHONE DATE <br /> pr <br />p <br />r <br />un <br />er m? <br />pe <br />n <br />n <br />v <br />r <br />anc <br />a <br />em <br />gn <br />) <br /> to assure Thal qualified perwnael properly gather and ealuate the infurmntian _ <br /> submitted. Itaud on m) inquiry or the Person or person. who manage the -tern. <br /> or thy' perstms directly rrspmcihlr for gathering the info m jtion, the information <br /> sufanilled is. In the hest of m% knowledge and belief, true, a urale, and complete. iJ <br /> llic+ for wMnitting fals <br />I u <br />wa <br />e th <br />t the <br />.i <br />nif <br />ni <br />i <br />form <br />tion SIGNATU OF PRINCIPAL EXECUTIVE ' <br /> m a <br />r <br />a <br />re are <br />g <br />ica <br />pena <br />e <br />n <br />a <br />. OFFICE OR AUTHORIZED AGENT AREA <br />TYPED OR PRINTED including the pansibilin of fine and imprisonment for knowing .iolation%. NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />3WTH 14 RE <br />CONTROL <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. _- • . This fS b 4-Part form.