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PERMITTEE NAME/ADDRESS(7nc&&f etNry)v..?L«arrat(/D(p6 w.l) <br />NAME <br />ADDRESS <br />J. BUX x}83 <br />';IA CO 81421 <br />FACILITY Z NO 2 MINE <br />LOCATION -f A CO 81421 <br />TAM S R GAt7 .10 M T hIC Mr -o <br />NATIONAL POLLUTANT DISCHAROE ELIMINATION SYSTEM (NPOES) <br />DISCHARGE MONITORING REPORT (DA4R) <br />PERMIT NUMBER DISCHAAOE NUMBER F i t <br />MONITORING PERIOD ! EF <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />NOTE: Re <br />Form Approved <br />OMB No 20404)004 <br />ad Iteetructione before comoletina this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY SAMPLE <br /> <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT , -r T( sr -;t ?1 ? ,t•.,1 .. , •. ; Z ;- " ;;"` _ ! f: <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />1 PERMIT ; ;_ • ?. t^ L <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT F <br /> REQUIREMENT <br /> <br />( SAMPLE <br />a MEASUREMENT <br /> PERMIT nc- r y ,: r <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT t a l; it Y <br /> REQUIREMENT <br />- <br />- <br />- <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER 1 nn'y <br />3F, Pe.. y o I.. <br />ieal this -mein and an rttwhn is were <br />v - <br />TELEPHONE <br />DATE <br /> prepared ruder my di-Alan or wpershlon In aerordanee with • %yet-designed <br /> to a-m that qu.nlled personnel properly gatl.er and e.ah'ate the Inrornutbn <br /> submitted. Bred m my Inquiry or the person or persons who manse the system, <br /> or thaw persmu directly responsible ror lathering the Information, the Informallon <br /> submitted Is, to the best or my knowledge and belief, [me• sommir, and complete. <br />' 1 am aware that them are allriflcaM penallles for submitting fair Inre'rmatlon SIGNATURE OF ?RIMCWAL EXECUTIVE - <br /> , <br />Incl <br />di <br />th <br />f n <br />d I <br />in <br />r <br />TYPED OR PRINTED u <br />ng <br />y o <br />ne an <br />e po.db <br />mpraenrnrnt <br />oc knowing -Wallorm OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND tArLAPIAIIVIr Vr nrvy VIVLP%IIVrva IHererencean erracnmenranerer <br />EPA Form 3320-1 (Rev 3/99) Previous editions may be used This is a 4-parr IOrTn. PAGE OF