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PERMITTEE NAME/ADDRESS Nnrlade Faciliq.\'ameLocarion if Diffrrenn <br />NAME <br />ADDRESS <br />BOX 670 <br />IDEN CO 61 <br />FACILITY --CA MINE COMPLEX <br />LOCATION EN CO 61 <br />V AKO, RECLAMATION MANAG <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />FROM YEAR MO DAY TO YEAR MO DAY <br />MINOR <br />(WEIR JC <br />F - FINA <br />OI5CHARC <br />Form Approved. <br />OMB No. 2040.0004 <br />a • <br />N)TE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO• FREQUENCY SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />r <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE r - i <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />f <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE -'( y <br /> MEASUREMENT l ( - `- <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE r <br /> MEASUREMENT <br /> PERMIT r . <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ... <br /> REQUIREMENT "• - ` '' <br />NAME(TITLE PRINCIPAL EXECUTIVE OFFICER I rertih under penalq of law that Ihie document and all attachment, were <br />ed <br />nder m <br />dire <br />o <br />tb i <br />u <br />m-isi <br />i <br />ac <br />d <br />with <br />c <br />t <br />d <br />i <br />d TELEPHONE DATE <br /> prepar <br />u <br />> <br />r <br />n <br />r <br />f <br />on <br />n <br />cor <br />ance <br />a a <br />s <br />em <br />es <br />gne <br /> to assurr that qualified pervmnel pruperl. gather and realuale the inform iion ' <br /> %uhmitted. Based on my ingwrn of the pervt)n or penons who manage the syatem, <br /> or those percom dirntle responsible for gathering the information, the information r ' <br /> .uhmilled h• to the be %1 of mi knowledge and belief, true, accurate, and complete. ' <br /> I am aware that there are signirlcunl penalt-. n for uhmilting false information SIGNATURE OF PRINCIPAL EXECUTIVE - <br /> <br />TYPED OR PRINTED . <br />ine•luding the r-ibilih of fine and impri,mnucnt ho knowing •iolations. <br />OFF CER OR AUTHORIZED AGENT <br />A <br /> <br />REA NUMBER <br />QQDE <br /> <br /> <br />EAR <br /> <br /> <br />O <br /> <br /> <br />AY <br />I.UMMr-N I J ANU CArt.MVIM I Iv17 yr A17 T <br />(r7emi-e'rrut! d(I d((dCf7l e"I'5 nerel <br />EPA Form 3320-1 (Rev 3/99) Previous editions may be used. 00350