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PERMITTEE NAME/ADDRESS(7.."For4kiyNws?L«.rraw((D(61,- ,? <br />NAME <br />ADDRESS <br />BUX 483 <br />)NIA CO 81428 <br />FACILITY ;I E h.{c', .2 MINE <br />LOCATION 1IN I A CO 81428 <br />" i 1 T OM A P=Ap . IP M T RI1=' Mr-P <br />NATIONAL POLLUTANT DISCHARGE EUMINAnON SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT /DMRJ <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved. <br />OMB No. 2040-0004 <br />MINOR <br />(SVBR MH) <br />F - FINAL G€ <br />CHRONIC WET TESTING FOR 006A <br />NOTE: Read Inotructione before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. <br /> <br /> <br />EX FREOUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT -## ;### REPORT <br />#*:? <br />###### <br />Thi. Y <br />;fiti^ <br /> REQUIREMENT S I NG-'-AMN <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ###? # ?r it 1 Cj'? :: ### # ;F k ;f - 77,. ! . y <br />i REQUIREMENT ;:;;•a <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ###### >#at## REPORT #?# #a###? 1 1 TRLY ,7MP-- <br />.7 C- REQUIREMENT S I NGSAMP <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ###### 3lRF?F91iFiF 100 ###### ###ihiFiE IfiL / ;) (?_, <br /> REQUIREMENT MN VALUE <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT r R r"=P GR' <br />;.;.- <br />_ REQUIREMENT S I NGSAMF' <br />r . SAMPLE <br /> MEASUREMENT <br /> PERMIT REPORT <br />:.. <br />?; -. <br />.:. r.. i=IT- .''. ; REQUIREMENT S I NGSAMP <br /> SAMPLE <br />.; MEASUREMENT <br />PERMIT iF #!F s;t ;r### REPORT <br />REQUIREMENT S I NGSAMP <br />dorumtnl and all a were <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I nerdy ° ndj, ty o law that this <br />TELEPHONE <br />l <br />t <br />DATE <br />r <br />pRpared under my my directbn or fuper per+tf <br />on In accordantt with th •syg sys <br />em ddEned <br />to more Ihat qualified personnel properly gather and evaluate the information <br />sobmiued. Bawd on my inquiry of the person or perverts who manage the system, <br />. <br />I <br />or those persons dlrertly mponsible foe gathering the Information, the Information - <br />st of m <br />knowled <br />d I <br />t <br />th <br />b <br />d b <br />lief <br />I <br />umir <br />o <br />b <br />lll <br />d <br />i - <br />y <br />su <br />m <br />e <br />; <br />o <br />e <br />e <br />ge an <br />e <br />, <br />rmo. we <br />. an <br />c <br />mp <br />ele. <br />SIGNATURE OF PRINCNAL EXECUTIVE <br />th <br />t th <br />ifl <br />lti <br />f <br />itf <br />I <br />si <br />t <br />b <br />r <br />l <br />I <br />f <br />TYPED OR PRINTED ere are <br />pr <br />c.n <br />pena <br />am aware <br />a <br />es <br />or wl <br />m <br />Jng <br />a <br />w <br />n <br />ofmadon, <br />Including the possibility of nrw and Imprbonme l for knowing Aolatlom OFFICER OR AUTHORIZED AGENT <br />- NUMBER <br />CODE YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIULAI I Ions (deferents off arracnmenrs noral <br />PPT PF^U17 9 OF ?._FTHAI- I TY OF_P I VS 4,57, " EFFFCT" , GWIWT}i ANG <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. This ,is $. 4-pan form. PAGE OF