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PERMITTEE NA ME)ADDRESS (7n.Io&,F dhry <br />Nwer/ orrron l/D(Qi.wnq <br />NAME <br />ADDRESS; L i aL <br />BOX 4$3 <br />IA CO 8148 <br />FACILITY E NO. M I NE <br />LOCATION 1 A CO 81428 <br />i r Au A nc Am to hAIr Ll= MP%C <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM INPOEM Form Approved. <br />OMB No <br />2040-0004 <br />DISCHARGE MONITORING REPORT WMR) . <br /> `?:VBR MH ) <br />PERMIT NUMBER DISCHARGE NUMBER - F INAL DE I <br /> - . LE ER TRL 'OTC O R UNMD TR I D <br /> MONITORING PERIOD <br /> YEAR MO DAY YEAR MO DAY <br />FROM TO <br /> NOTE: Read IMtnfctfone before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREOUfNCY SAMPLE <br /> <br />EX OF <br />T <br /> ANALYSIS YPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT iE# ### REPCrw Y ' 7 ?tit?L <br /> REQUIREMENT <br />• <br /> <br />. <br /> INST T; , <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />I certnly e ., pe.. IT o Is. Ihot this document end Itt sltechmentl were <br />TELEPHONE <br />NAME/TfTLE PRINCIPAL EXECUTIVE OFFICER <br />DATE <br />prepsr.d under my dlrrctlon or supervision In eccordencr with I system designed <br />le o""" 'hot qulMBed personnel properly plher and ereluste the Inforwtellon <br />.obmlued. Breed on my Inquiry of the person or persons who manste the system <br />or those persons dlre lly responsible for tethering the Informallon, the Information <br />submitted I& to the bnI of my knewledte snd better. Ira., smure'e. Ind complete. <br />I am s.srr that then err slgndM1un' penalties for mbrtiltin <br />rslse Inrormation <br />SIGNATURE OF PAINCWAL EXECUTIVE - <br /> <br />TYPED OR PRINTED g <br />, <br />Inchding the possibility of fl ¦nd Imprisonment for knowing elelatlons. <br />OFFICER OR AUTHORIZED AGENT AAEA <br />CODE NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION Ur ANT VIOLA I IUN5 /Reference en errecnrnenrs nere) <br />"r wrTl T i "! !•?T'? 1.`.'?;?;7 r?`n1-^ Ye '?c i,nl?f-'T•li <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used This is a 4-Pert Corm. PAGE OF