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PERMITTEE NAME/ADDRESS (/nclyde Fadary Namr/Lacanea if D;gaam/ <br />NAME ,: VF N•. U;3 ~7`yh1FA 'v:ALLE'i Gf:1 F-',:_ '. .Llh." <br />ADDRESSgINES 1~ 2yv3 SOUTH, W L'CV,MAPJ f'i`•. <br />!~3-0G~•6A:nF-GI-F-NERAL--6•FA((;IaE i'751~ RCR <br />ii~:~g'G3a[3~ Jak Creek CD 8or~:, 81i4' <br />FACILITY <br />LOCATION .~ <br />Richard i~^iil.ti ~ ~ , <br />r-TTr.i: t1f_3RR~~-w--+rl=~r_>~'rr-G`PN~PtAt'i9TNY.:, <br />AN <br />PARAMETER <br />AVERAG~ <br />"AIW,`~'A1VE~z-. T1j~f ril. SAMPLE "' 14{`"fi <br />',=COVL•Rr, r'i_I: MEASUREMENT <br />1 2 ~ i .-, O .'e'TGFiM ~ . _ <br />-FF!JJ<:PJ7 GROSS VALUE ~ ~~~ <br />~£7CJ1f~EM~NF <br />L.CW. It! CONDUIT OR SAMPLE <br />''-iP" Trt,=,TMENT FLANT MEASUREMENT G~(~~,g <br />•_tOSU O O 'x'w =, <br />FFLU(_N': GROSS VAGUE H~Gi N7~ , <br />SAMPLE <br />SAMPLE <br />SAMPLE <br />MEASUREMENT <br />SAMPLE <br />SAMPLE <br />NATIONAL POLLIfrANT DISCHARGE ELIMINATION SYSTEM (NPDES) Form Approved. <br />~' DISCHARGE MONITORING REPORT (DMR) :^,~ ~ r OMB No. 2040-0004 <br />PERMIT NUMBER "- - DISC ~MBER ~ ~ R 0'.? t ~.. <br />M RING PERIOD F ;'~ :IMF F T 7C.1 FQ I DEL C F <br />YEAR MO '~ .r ,FAR MO DAY ~ ~ ~j, " --- <br />FROM +~ ~ ~ r ~ - 1'JL~ J 13G1,'YIMs6E l I +r~~ ~ <br />~.. 4 NOTE: Re Fluctions before~orgPl4ting this form.. <br />~` MAXIMUM ,UNITS MINIMUM <br />p, 03S <br />t, <br /> <br /> '~~ rs a ~`~ s ~§l;~ ~' ~ "'~'yvTa~^~yy{9,ff~~~'R $-" a <br /> , ' <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CedAy untlar panalry of law Nat Nls dottlment antl all attachmems were <br />' ' <br />, ' <br />TELEPHONE DATE <br />prepared untlar my direction or super~slon in accordance wi17M a system tlesignetl <br />R 1 : rl n rd I °, i C tp assure that quaMSeO personnel prof lerlygather end evaluate the oformaaon ~ <br />_ <br />~ <br /> <br />submitted. Based on my hrquiry of the parson or parwns who manage iha system, <br />Lnvir:,nrnent, l •'udne~' <br />~ ~ ~j~ <br />~ [~ ~%.8 -Z ~ 1 z <br />or Nose persom directly responsible br gethering the Irtlormation, Ne infonnatlon -, ~ <br /> <br />aubmidetl is, to the best of my knowledge end beIIH, true, accurate, end complete. <br />SIGNATbRE OF PRINCIPAL EXECUTIVE I <br />' / <br />I am aware Nat Nere ere eign~cant penalties for submining lake information, <br />TYPED OR PRINTED InGUtlin the sibili olfineantl im risonment for knowin violations. .OFFICER OR AUTHORIZED AGENT <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />;'.`.~iFRl9Li~~~ .3C~IiAY AVERAGE- CONCENI~RATION t)51PJG A hJURMAL Ah'1TN METiC MEAN Uf AI_t_ .~'-l".f~! Y h~iSULi., ~1GTAiNFL) F~RUM <br />':~,AMPLES +:ULLEC~rED AT POINTS OOlAr 005A AND 00%A DURING l-HEi. REPC)RTING FERIGD-~:.. B 1, Pu 1K. <br />EPA form 3320.7 REV 3/99 Previous editions ma be used. <br />( ) Y ~I PART FORM PAGE <br />00113/Opi'l~j '~ 1 OF <br /> <br />AVE GE <br />G I ~41~2 <br />t <br />. .. ,r <br />,.'y <br />VTAATION ~ NO:' FREOUENC SAMPL <br />' ~ .l'.X~ '. OF TYPE <br />I' NfAXIMUM UNITS" ANUysa <br />_ l ) <br />'' `y1 ~ m ~~T$ pLGtr <br />- ~~Z~ CALCtD <br />#+t <br />~rtaf ~~' <br />• yr <br />,'.F. 't ~~ tt# <br />s l'f <br />t <br />