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PERMITTEE NAMEIADDRESS dotclade Fardi(Y.Yamellluarion if lFfferrwt NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />NAME DISCHARGE MONITORING REPORT (OMR) <br />ADDRESS <br />1 ) X PERMIT NUMBER DISCHARGE NUMBER <br />FACILITY EA . M I f??c MONITORING PERIOD <br />LOCATION YEAR MO DAY YEAR MO DAY <br />EN CO 81,41" FROM TO <br />( KAROP RECLAMATION MANAGE" <br />Form Approved. <br />OMB No AI40.0004 « <br />MINOR <br />(SUBR <br />DSCHG <br />NOTE: Read Instructions before completing 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 j -) <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE _ <br /> MEASUREMENT ` <br /> PERMIT i- <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT . , <br /> REQUIREMENT <br /> SAMPLE <br /> <br />MEASUREMENT <br />I <br /> <br /> PERMIT <br /> REQUIREMENT !. - . <br /> SAMPLE r ?q <br /> MEASUREMENT [l - - <br /> PERMIT - <br /> REQUIREMENT <br /> SAMPLE <br />` t <br />' <br />! '' <br /> MEASUREMENT - <br />, . <br />r L <br />_ ?? Uri .; ,.r% <br /> PERMIT ' !.,F tI F <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT t .. :. _ <br /> REQUIREMENT <br />NAMEfnTLE PRINCIPAL EXECUTIVE OFFICER I ecrtin under penalty of la% that this deaumeat and all attachments wetx <br />d <br />d <br />di <br />i TELEPHONE DATE <br /> prepare <br />un <br />er m? <br />rect <br />on or wprrvisin in accordance with a system designed <br /> In a»un• that qualified Personnel properly gather and evaluate the information <br />, <br /> submitted. Based on m? ingtdrs of the prawn or prmut% whit manage the %,tem. <br /> or thox pemat%dirrcdi re punsible for gathering the information. the infurtnalion <br /> submitted is. if, the hest of and knowledge and helier, true, accurate, and complete. -? Z <br /> I um aware that there a" i <br />nificani <br />enalties for submillin <br />fal <br />e i <br />fo <br />tio SIGNATU OF PRINCIPAL EXECUTIVE J <br />TYPED OR PRINTED g <br />p <br />g <br />s <br />n <br />rma <br />n- <br />including the I-ibilits if fine and impri-mcni for knowing violations. OFFIC R OR AUTHORIZED AGENT AREA NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />E CT TO BURDE <br />EPA Form 3320-1 (Rev. 3(99) Previous editions may be used. T7tk` t%' 3 4-hart form.