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PERMITTEE NAMEIADDRESS (Include FacilityNamelf. anion if Different <br />NAME ?I•I'r <br />ADDRESS _ ':FLEX <br />-ox 670 <br />'scN CO 81635 <br />FACILITY '=CA MINE COMPLEX <br />LOCATION -: O 81635 <br />BEN C <br />Y' KARn, RFCL AMATIf3N MANAGER <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPOES) <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 ApWved. ! <br />OMB No. 2040-0004 <br />F <br />D: <br />NOTE: Read Instructions before comoletinq this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREOUENCY SAMPLE <br /> OF <br /> EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE I r" r <br />I <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />MEASUREMENT - `7 <br /> l <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 />L <br />F <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I cerilfy under pcnall or law that this document and all atlachmenh were <br />nd <br />r <br />ti <br />d <br />di <br />ki <br />I <br />f <br />h TELEPHONE DATE <br /> prepare <br />u <br />m% <br />rec <br />on or supers <br />n accun <br />ame wit <br />e <br />un <br />a system designed <br />to assure that qualified perainnel properis gather and estduate the information <br /> submitted. Rased on m% inquiry of the person or Persons who mange the ygem. •` <br /> or thine persons directly responsible for gathering the information, the Information <br /> submitted is, to the hest of my knowledge and belief, true, a urate, and complete. . J ` 1? <br />?, <br /> I am aware that there are signincanl penaitkn for submitting false information. SIGNATU E OF PRINCIPAL EXECUTIVE `. -• <br />.1 <br />TYPED OR PRINTED including the possibility of fine and imprisonment for knowing siolations. OFFIC R OR AUTHORIZED AGENT AREA NUMBER YEAR MO DAY <br />".. ?.. ......... .... ...,?.....,. 1. ?., .Q,o? / Aik <br />IRED TO BEQUEST A REASONAB!_ OP <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. This is a 4-part form, PAGE OF