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PERMITTEE NAME/ADDRESS Nnclude Facility Name/Location if Different) <br />NAME <br />ADDRESS .:.. r'.: . - L ?. <br />670 <br />CO B1639 <br />FACILITY MINE COMPLEX <br />LOCATION j Q L <br />:11639 <br />r,o?FO, RECLAMATION MANAGER <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPOES) <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 />PBCHG TO <br />Form Apprpved. • <br />OMB No. 2040.0004 <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO• <br /> <br />EX FREQUENCY <br /> <br />F <br />O SAMPLE <br /> <br />TYPE <br /> ANALY <br />SIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE r1 + t <br />/ ' <br />° <br /> MEASUREMENT u = ( <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE ;t j I f <br />?" <br /> MEASUREMENT - <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE l <br />i <br /> MEASUREMENT <br /> PERMIT - r <br /> REQUIREMENT <br /> SAMPLE 1 l <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ##jf#q k # <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT f_.I .. _ <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAMENITLE PRINCIPAL EXECUTIVE OFFICER i <erur. under penalt% of law that this document and all attachments were <br />re <br />ar <br />d under m <br />direction or su <br />enkitn In accordance with a s'tstem desi <br />ned <br />' TELEPHONE DATE <br /> p <br />p <br />y <br />e <br />p <br />g <br /> to -ure that qualirtad prrsomtel Properly gather and eoaluate the information t <br /> submitted. Based on my inquire of the person or persuns who manage the system, <br /> or Ihtne porsons directly responsible for gathering the inrormation. the Information <br /> submitted is. to the bey of my knowledge and belief. true, accurate. and complete. <br />I am aware that there <br />re si <br />nificant <br />enaltks for submitting r,d, nf-ination <br />SIGNATURE OF PRINCIPAL EXECUTIVE -? <br />TYPED OR PRINTED g <br />a <br />p <br />. <br />including the po otlbiBts or fine and imprisonment for knowing u• 6ni„o„ OFF ER OR AUTHORIZED AGENT AREA NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />EPA Form 3320.1 (Rev. 3/99) Previous editions may be used. 'niis is a 4-par't fornl. PAGE OF