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PERMITTEE NAME/ADDRESS Unefude Faeifity Name/Locmion if Di,(fenntf NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS i <br />B(JX t PERMIT NUMBER DISCHARGE NUMBER <br />`EN MONITORING PERIOD <br />FACILITY =CA MINE CUNif i_E., YEAR MO DAY YEAR MO DAY <br />LOCATION 'DEN Co 816 FROM TO <br />ir;.cn 12V( -I AMA'rTrIIU MAR1Ll(_1=t <br />Form Approved <br />OMB No %40-0004" <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION 010, FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> <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 />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER 1 verli4 under penalty of luw that this document and all attachment were TELEPHONE DATE <br /> prepared under m) dirMi.x1 or capers ision in accordance w ith u spsiem dr.+ignld ? <br /> to assure that qualified perwmnel proper-11% gather and esaluaw the inrormation <br /> .uhmitted. Rased in my inquir) of the pervm or prrwms who manage the s.aem. <br />or chow perwt" direc•ilr mpimsihlr for gathering the infortnathar, the information 1 - <br /> .uhmilled Is, to the best o( m) knowledge and belief, rear, accurate. and complete. <br />SIGNAT RE OF PRINCIPAL EXECUTIVE <br /> I am uwarc that there are signinvant penalties ror wbmitting false information. AREA <br />RINTED ruonment for knowing silatlons <br />incl <br />din <br />the <br />ibiliq rdFine and im <br />r OFT ER OR AUTHORIZED AGENT NUMBER <br />DE YEAR MO DAY <br />TYPED OR P p <br />. <br />u <br />g <br />P <br />CO COMMENTS AND hAVLAIVAIIVN Ur ANT VIULA11V1VJ (I'MiUrCriCrU all rllirlUlllIICIIW ncral <br />?(")WTH Pr. REPROD DERIVATIONS AS "TOXICITY". RPT LOWEST <br />lA CONTROL WAS OBSERVED USING TEST CODE "SFr. RPT <br />EPA Form 3320.1 (Rev 3/99) Previous editions may be used. 00224 ' 'Mi% is a 4-(fart form.