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PERMITTEE NAMEJADDRE9S(tndri Fo AryAfa dLoearron(/D(Qbwrr) <br />NAME <br />ADDRESS 1•i 1.4 i <br />LO X 483 <br />IA CO 81429 <br />FACILITY = N O. 2 MINE <br />LOCATION [A CO 81428 <br />T.%t t % n=Ail IA MTIUI= M1-"R <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPOE.S) <br />DISCHARGE MONITORING REPORT (DMRI <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 />NOTE: Road Instructions before completing this form. <br /> <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. <br /> <br />EX FREQUENCY <br />OF SAMPLE <br /> <br />YPE <br /> ANALYSIS T <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT C i f1Uh' <br /> SAMPLE <br />141J <br />_ MEASUREMENT <br />. <br />I PERMIT <br />TENT ;".s' /?,• REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br />PERMIT <br />W <br />N -RAE <br /> REQUIREMENT AVG i .k MONTH <br /> SAMPLE <br />'. MEASUREMENT <br /> PERMIT <br /> REQUIREMENT .3,") DA ,Y : I <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT h :. ?_ zf 10 .. . <br /> REQUIREMENT I NST MAX G <br />N C?vDIJI T SAMPLE <br />A TMENT PL,: <br />MEASUREMENT <br />- PERMIT REPORT '.EPORT -. --_ r <br />j.. REQUIREMENT ILY I-s <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT 3 7TUAL <br /> REQUIREMENT T NST <br />TLE PRINCIPAL EXECUTIVE OFFICER <br />AME ' C ' under penalty .(low that th is eoeement and .w.narnmerru wen TELEPHONE DATE <br />N <br />M prepared under my dlrectlon or aupe rA on In accordance with a system ddgned <br /> In aan that quanned penonnei properly [other and evOuale the Information <br /> sobrrrlted. owed on my Inquiry of the person or persorn who reumage 11w,yetem, <br /> or Chow pence directly relpornlble for gathering the Informall°n• the information <br /> wbmllled to, to the beat of my knowledge and belle!, true, constr. nrd complete. <br />ln <br />th <br />t th <br />i <br />t <br />drl <br />f <br />b <br />rlti <br />r <br />I <br />f <br />ti <br />I <br />t <br />S143NATURE OF PRINCIPAL EXECUTIVE <br />TYPED OR PRINTED ere an s <br />gn <br />can <br />pen <br />n <br />am -are <br />a <br />a <br />or m <br />m <br />ng <br />a <br />ee <br />orma <br />on, <br />I-Iodine the powlbility of flew and Imprisonment few knowing Ao1*Uena OFFICER OR AUTHORIZED AOENT <br />NUMBER <br />A DA <br />CO E <br />YEAR <br />MO <br />DAY <br />_ <br />- <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Roforenc• dl srrachmenrs horel <br />f-' „'^, L Tr r•I nr,n.;r-ryt.!", ray ?-JOCI' <br />THIS <br />A Fo rm 3320-1 (Rev 3/99) Previous editions may be used is a 4-P8rt form PAGE OF <br />EP