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PERMITTEE NAME/ADDRESS ilnclude Facility.1amellncation if RiJferenu <br />NAME <br />ADDRESS <br />-7Ci <br />n; CD Aib3`i <br />FACILITY CA MINE COMPLEX <br />LOCATION J F 'N C0 81639 <br />:Y V AR171, RFt'I AMAT rnN MANAGER <br />Form Approved. <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) OMB No. 2040-0004 <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />t:?!SaZGE CFZ?jLr+. <br />MONITORING PERIOD / <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO" FREQUENCY SAMPLE <br /> OF <br /> EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <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 /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAMElTITLE PRINCIPAL EXECUTIVE OFFICER I tertifs under penalts or lass that this d,wunwnt amt all attachment, were <br />a <br />ed t <br />der ms di <br />ti <br />i <br />i <br />i <br />d <br />i <br />h <br />i <br />d TELEPHONE DATE <br /> pmp <br />r <br />in <br />rec <br />on or supen <br />un <br />s <br />n u ior <br />ance w <br />t <br />a s%tcm des <br />gne <br /> to assure that qualiried Personnel properh gather and es aluate the information <br /> wbmillcvl. Based on m? inyuin of the person or persons who manage the system. <br />i <br /> or those persons dirrcU'i r-latnsible for gathering the informat <br />on, the information - - 1 <br /> <br />submitled is, to the bet or ms knowledge and Niter. Into, accurate. and complete <br /> <br />I , <br /> I .on aware that there are significant <br />enalties for suhmilting false inrormation SIGOATURE OF PRINCIPAL EXECUTIVE `= <br />TYPED OR PRINTED p <br />, <br />auludutg the lot-bilit> of rine and imprisnnmrnt forknowing siolations. OFFICER OR AUTHORIZED AGENT AREA NUMBER <br />CODE YEAR MO DAY <br />60VmMC1YIa mislu CAFLMI\m11V1s1 Vr Misty vows-m1IV19a (r7ClererlGe ale audcnmenrs neral - <br />!DS LIMIT APPLIED FOR =10YRr 24HR PREC:IP EVFNTi TSS, <br />24HR PRECIP EVENT SUBJECT TCI BUr^CEN OF PROOF i A 3. <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. .' .? zi.:7. This is 3 4-Part torn.