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PERMITTEE NAME/ADDRESS tinclude Facility Vomell"ation ifihffenmt <br />NAME <br />ADDRESS _x <br />BOX. 670 <br />DEN CO 91639 <br />FACILITY -CA MINE COMPLEX <br />LOCATION _IEN CO 81639 <br />•1 IKS t0(1 P17ri AMOTTf-1KI MANIAnFR <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES) <br />DISCHARGE MONITORING REPORT (D R) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form AppWed. s <br />OMB No. 2040-0004 <br />MINC <br />t5UD <br />BSCN <br />NOTE- Road In0nirtinnc hpfnrw rmmnlwtinn thin fnrm <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO• FREQUENCY SAMPLE <br /> OF <br /> EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE f / <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT .,• I <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT F. _ r, ._ , <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT ` - L . <br /> PERMIT <br />i <br /> REQUIREMENT 1 L' i <br /> SAMPLE <br /> <br />.: 1 iii_._ ?..' 11l- <br />MEASUREMENT or, <br />Q ' <br /> PERMIT <br /> REQUIREMENT <br />i <br /> SAMPLE <br /> <br />• <br />MEASUREMENT O , I <br /> PERMIT <br /> REQUIREMENT ; 't `•' <br /> SAMPLE <br /> <br />MEASUREMENT <br />I l <br />'- ' ?,• <br /> <br />PERMIT <br />t' <br />70- <br /> REQUIREMENT _ <br />NAMEfrITLE PRINCIPAL EXECUTIVE OFFICER I certify under pnalt, of la- that this document and All Attachments -err, <br />r <br />d <br />di <br />d <br />'ti <br />TELEPHONE <br />DATE <br /> r re <br />un <br />er m* <br />m <br />mt or su <br />p pa penisitm in uttordaeue with A s?'stem designed <br /> to assure that quAlirnd personnel properli Father and rsaluAte the informAlion ? <br /> wbmitted. Rast d on my inquin of the prrcon or W -n% --hu manaler the -tem. <br /> or those prrsons directh resp,mible rnr gathering the Information. Ibe into' rnmtion -? <br /> submitted is. In the "to( m, km,-ledge and belief. true, wvurAte. And complete. ) 1 <br /> <br />I Am a-arc that there am significant <br />enal ies for subo <br />ilti <br />false i <br />fo <br />ati <br />n S1GNA RE OF PRINCIPAL EXECUTIVE l L 0 <br />? <br /> <br />TYPED OR PRINTED p <br />t <br />ng <br />n <br />rm <br />, <br />o <br />including the pn.ibilit% command impris.-tmrnt rnr kro-inq %iola k,n. <br />OFF ER OR AUTHORIZED AGENT <br />AREA NUMBER <br />YEAR <br />MO <br />DAY <br /> CODE EPA Form 3320.1 (Rev. YN) Previous a bons may be used. . This i% a 4-part form. <br /> <br />