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PERMITTEE NAME/ADDRESS (include F"WY Name/Location iJDifJereai) <br />NAME <br />ADDRESS <br />BOX 26 <br />;_A 1:0 8I ??24 <br />FACILITY HOR I Z . 1 MINE <br />LOCATION CO _H 81424 <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 />M z 1`40R <br />( 5UBR MH <br />F - FINAL <br />Form Approved <br />OMB No 2040-00cl-I <br />M NTRE-`? <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. <br /> <br />EX FREQUENCY <br />OF <br />YSIS <br />N SAMPLE <br />TYPE <br /> A <br />AL <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br /> <br />E R'ci'GR <br /> <br /> <br />CF= i L i•': <br /> <br /> <br />; l:_',PJ T ?:; r.,. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT -rte#?t <br />REQUIREMENT, =ORT <br />_i A)A AVG REPORT <br />DA I <br /> SAMPLE <br />- MEASUREMENT <br /> PERMIT <br />REQUIREMENT 3r L a :??s REPORT REPORT <br /> <br /> SAMPLE <br /> MEASUREMENT <br />r, PERMIT <br />REQUIREMENT <br />DAILY M <br /> SAMPLE <br />MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br />NAME)TITLE PRINCIPAL EXECUTIVE OFFICER I certify under penalit of la% that this document and all attachment were <br />prepared under m, direction or supenicion in accordance with a system dedgmd TELEPHONE DATE <br /> to assure that qualified personnel pr,Wert% gather and esaluate tha• information - -- -? - <br /> suhmittrd. Rased on mp inquin or the person or persons who manage the s*'stem. _ <br />- or th- persons directly responsible for gathenng the information. the information <br /> uhmitt d is, to the best of my kn-Ittige and belief. true. accurate, and complete. SIGNATURE OF PRINCIPAL EXECUTIVE <br />_- <br />I y / I am aware that there am significant penalties for submitting ful.e information, <br />AREA <br />TYPED OR PRINTED including the pussibilits of fine and imprisonment for knowing siodations. OFFICER OR AUTHORIZED AGENT NUMBER <br />ODE YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all affacnments nere) <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. :'3C` `i7riS:3a'4-pt''fotm.