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PERMITTEE NAMEIADDRESS (Include PaciWy Namellom6an ijDifferenu <br />NAME <br />ADDRESS <br />BOX 670 <br />BEN CO 81639 <br />FACILITY NCH MINE COMPLEX <br />LOCATION FN CO 81639 <br />v ARO, RECLAMATION MANAGER <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Apigg,oved- <br />OMB No'2040-0004 <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO• FREOUENCY SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE j , <br /> MEASUREMENT <br /> PERMIT _ <br /> REQUIREMENT <br /> SAMPLE <br />/ <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT JF, L. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT :? . <br /> REQUIREMENT <br /> SAMPLE i <br /> MEASUREMENT '' !( 0. <br /> PERMIT a; +s - <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT l <br /> PERMIT ` <br /> REQUIREMENT <br /> SAMPLE \ LJ r <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I rerlin under penalt, of law that Ihi, d-.... -l amt all aunclnn"t, were <br />r <br />d <br />lion or su <br />% <br />Itm desi <br />ar <br />d <br />di <br />-lo <br />n i <br />rd <br />n- <br />ith <br />ned TELEPHONE DATE <br /> p <br />- <br />ep <br />r <br />un <br />er m? <br />m <br />l <br />o <br />n acco <br />a <br />w <br />a <br />g <br /> to a wrr that qualified personnrl properl-s gather and e,atualr the information <br /> suhmiltrd. Rwwd, m} inquir, of the person or person, who manage tN-.,stem. <br /> or th- Fwmm, direrd% rr,pm,ible for gathering tin information. the information <br />r <br />[ <br /> <br />,uhntitted is, to t Ix•,t of r knowledge and belief, true, accurate, . and a e. <br />I am .-are that lb Iheie arr .ignifivanfaant pennltir, for ,uhmittingng fa fidlse i nfnrmationotinn. <br />SIGNA RE OF PRINCIPAL EXECUTIVE } <br /> <br />• _ <br />TYPED OR PRINTED including the I-iboht. of fur and in pri onment h,r knowing %iodatiom. OFF ER OR AUTHORIZED AGENT AREA Conr NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANAlwrv Uh ANY VIULAIIVNS (Heference all attachments here) <br />EPA Form 3320.1 (Rev. 3/99) Previous editions may be used. ' '-rT I1FS.1ti a $-?Teft f(11TT7.