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PERM177EE NAME/ADDRESS flnclude Facility V'ame/L carian if Di erenu <br />NAME <br />ADDRESS <br />CO 8163 <br />FACILITY MINE COMPLEX <br />LOCATION F C O 0 1 6 3 <br />GMATTflfil MAI\IAr_%PP <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES) <br />DISCHARGE MONITORING REPORT (D R) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />MINOR <br />(5UBR JC <br />F - FINA <br />SC HG TO <br />Form Approved <br />OMB No. 2040-0004 <br />• I* <br />fdf)TF Rood Inctr??runr,o i,..i...., ?., ...., ,..?,.., •ki- 1,...., <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY SAMPLE <br /> OF <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE <br /> SAMPLE - - <br /> MEASUREMENT <br /> PERMIT _ - < <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT I I <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />-J <br /> PERMIT - i L-IR t _. rr <br /> REQUIREMENT - <br /> SAMPLE <br /> <br />MEASUREMENT _ <br /> PERMIT l 77 <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT ` ac, U . I <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certif% under penalty of luw that this document and all attachment, were TELEPHONE DATE <br /> prepared under m% direction or supers isiwn in accordance with a systrm designed - <br /> In assure that qualified peramnel prvperly Rather and rs aluate the information - <br /> suhmill d. Based on my inquin of the persm or persons who manage the system. % <br /> or those persons directly resplmsihle for Lathering the inrormaion. the information <br /> submitted is, hl the b, ,l ur ms kti-k,Ikm and hellef. Inle• ascuraw and compleie. <br />I am aware that there air si <br />nifica <br />t <br />e <br />alties ro <br />ub <br />itti <br />i <br />f <br />l <br />f <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />/ ( <br />• <br />iJ <br />TYPED OR PRINTED g <br />n <br />p <br />n <br />r s <br />m <br />ng <br />ormation, <br />a <br />+e <br />n <br />including the possibility of fine and impris mmenl fur knowing tiolutions. 011FICER OR AUTHORIZED AGENT AREA - <br /> <br />/a11????r?1Tn w?1n -nl A\IATIr1kl AL A\IV \11/11 <br />ATtA?1n ODE NUMBER YEAR MO DAY <br />- <br />AFT <br />PER <br /> <br />EPA Form 3320-1 (Rev. 3HJ9) Previous editions may be used. `''=' = 1 1 Tfli,, is a 4-patNf0ml.