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PERMITTEE NAME/ADDRESS t7.d6 l F.rWry N..?L.rar,.n ((D(F,.U) <br />NAME <br />ADDRESS <br />i. BOX 483 <br />:lNTA CO 81428 <br />FACILITY ) I E W.I. 2 M I Ng <br />LOCATION °IN I A CO 81 4213 <br />ILL I AM A. DJ=AR JR. MINE hiGR <br /> )t <br /> <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM fIN <br />M <br />POES) -' 1 <br />?' Form Approved. <br /> <br />OMB No 2040-0004 <br />DISCHARGE <br />ONITORING REPORT WMR ) - NOR <br /> )BR MH) <br />PERMIT NUMBER DISCHARGE NUMBER - FINAL <br />DPI <br /> R <br /> MONITORING PERIOD % DEER TRL OTC, O I B <br />R UNMD T <br /> YEAR MO DAY YEAR MO DAY <br />FROM TO - <br /> NOTE: Reed knetrtlctlone Wore completing this form. <br /> <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 /> T i <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT :;. ;.. .; .? r . <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT T / <br /> REQUIREMENT ;,I l tON I l <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT F'FP OI? <br /> REQUIREMENT - . <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT r _ <br />REQUIREMENT <br />1 rertttr under Dena ly or I- that thk doeument and aN attachments wen <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER <br />TELEPHONE <br />DATE <br />prepared under my dirs<tton or supenMston In accordance with a system deyinee <br />to care that qumhntd personnel Properly gather and erah>ate the Information <br />submitted. Board on my inquiry, of the Person or persons who manage the system, <br />or those pen.rs chnetly respontlble for gathering the Informallon, the Inrormallon <br />submitted Is, to the bal of my knowledge and belief, Ime, sccvr ti.. and complete. <br />I am ¦w.rs that time an dgnlncant pen¦ltlb for submltnng rave Information <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />TYPED OR PRINTED , <br />Including the possibility of nne and Ittrptlsonttsenl for ?nowing 0a4uorti OFFICER OR AUTHORIZED AGENT AREA <br />CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Re%rence ell errechmenra here/ <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used This is a 4-Part form. PAGE OF