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YGRMI I iEE NAME/ADDRESS (Include Factlr{v .Vane/Location VDia'aenr) <br />NAME <br />ADDRESS <br />BOX 670 <br />--EN CO 8163' <br />FACILITY -.A MINE COMPLEX k <br />LOCATION , E N CID 8163' <br />t' KARO, RECLAMATION MANAGER <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />DISCHARGE MONITORING REPORT (DM R) <br />I <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />FROM YEAR MO DAY TO YEAR MO DAY <br />Form Apotoved. 0 <br />OMB No. 2040.0004 <br />MINOR <br />(8UBR JC) <br />F - FINAL RUU <br />I)SCHG TU TRIB/DRY CREED; <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. OFFREQUENCY SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE l I < <br />( ' <br /> MEASUREMENT (`- v L) <br />v v' <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE ( < r i. <br /> MEASUREMENT -? - <br /> PERMIT .: <br />I <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT ' <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />, ` <br /> MEASUREMENT <br /> PERMIT ' .. :Jr. *_.. _ <br /> REQUIREMENT <br /> SAMPLE ` <br /> MEASUREMENT _ I <br />' PERMIT _ <br /> REQUIREMENT .t <br /> SAMPLE <br /> MEASUREMENT <br /> - c <br /> PERMIT <br /> REQUIREMENT L. I LY t' <br /> SAMPLE L „' ` 11 <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAMEITITLE PRINCIPAL EXECUTIVE OFFICER I eertif> under penaitq of law that this dm•ument and all attachments were TELEPHONE DATE <br /> ptePand under ms direction or ww,Won in anordarim with a st ttrm designed <br /> to assure that quatiried penwmnet properl% gather and rsalualr the information - <br /> submitted. Based on m} inquin of the person or perxmi, who manage the .stem, q <br /> or thine persons dim-ett? responsible far gathering the inrormatioo, the information <br /> b <br />the hest of <br />knowledge and belief <br />true <br />mrurale <br />and -m <br />kle <br />itt <br />d Is <br />it ? <br /> , <br />. <br />, <br />, <br />p <br />. <br />m <br />e <br />mi <br />su <br />, <br />SIG TURE OF PRINCIPAL EXECUTIVE <br />- - I J <br /> <br />TYPED OR PRINTED 1 am aware that their air signiri"nt penalties for submitting false information. <br />including the msihilit> of fine and im tnonment for knowing siulati,ms. <br />w v O FICER OR AUTHORIZED AGENT AREA NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />INABLE POTENTIAL ANALYSIS BE <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. This is a 4- Part-form. PAGE OF