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I PERMITTEE NAME/ADDRESS (Include Faciliry•Namr/Ltranon ifDiB~^t) NATIONAL POLLUTANT DISCHARGE ELIMINATION SY$TEM (NPDES)
<br />1 NAME ~ w- r ~ DISCHARGE MONITORING REPORT (OMR)
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<br />Form Approved.
<br />OMB NO. 2040-0004
<br />ADDRESSEDI{AyNINE ~ ..aV-.-• '-o., "_.,~•.V r naD a nnT (5U9R Nil)
<br />P • D. " 80I 6 S 18 PERMIT NUMBEq DISCHARGE NUMBER F _ FINAL RO U "
<br />FACILITY EHGLEaOJ~D C7 tl0155-6518 MONITORING PERIOD SURFACE RUNOFF TO OAK CAEF,K
<br />LOCATION .' YEAR MO DAY YEAR MO DAY
<br />FROM 00 09 01 70 00 09 30
<br />~ ##tr RO DISCHARGE '~#~
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<br />"" QUANTITY OR LOADING QUANTITY OR CONCENTRATION NO. PREOUEMC SAMPLE
<br /> EX OF TYPE
<br />PARAMETER ~
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ANALr$IS .
<br />8 SAMPLE ##O#P# k+Otd+bYt ~####'.: ( 12)
<br /> MEASUREMENT
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<br />'FFLUENT GROSS VALUE
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<br />iOLI DS, TOTAL SAMPLE #pp00tr ####Op ##O:trGM ( I9)
<br />USPENLIEU MEASUREMENT '
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<br />PFLUBNT GNUSS YALUK ~ ', e~ ` ' "~< IktO a:~ ~''~ ` ~
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<br />'DUDS, SETTLEAPLE SAMPLE aaasam gtK.Faaa OlsotOtoO ( ~,)
<br /> MEASUREMENT
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<br />._~. d GAE.4:;I? - SAMPLE FC:ArR4tr _ C###k# # ### ####h-,`• ( 1~+)
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<br />DENT GRO5S VALUE •
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<br />b`~e TOTAL SAMPLE >rn#7R? 4i:tr#D ###::.# ( 19)
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<br />FFLUEtI 68055 YALUR GD *~i#
<br />iOLIDS, TOTAL SAMPLE ##aaka
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<br />NAMElTRLE PRINCIPAL EXECUTIVE O LCaniry
<br />FFICERS under penalty of law that
<br />i this document antl all atte
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<br />i cnments were
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<br />.prepared antler my diretl
<br />-~ ^ t p..N ~`"~Z~w-~~ to assure that qualifatl personnel properly gather entl erWUate Ule trdormation
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<br />submittatl. easetl rM my inquiry of the person or persorrs who manage the system, ~
<br />' or those persons tlirectly responsible br gaNedng the inlormetton, Me iMOnnetion
<br />(ant I q~Ir_ submittetl is , to the best Mmy knovAeGge antl belief, true, accurate, entl complete. '
<br />SIGNA RE OF PRINCIPAL EXECUTIVE ~ Tj10 '4
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<br />I am aware Utei mere ere signRiWrrl penalties for submitling false lnbrmation,
<br />TYPED OR PRINTED indutlin the ssibili of line ens Im risonmem for knowln violatlons. OFFICER Oq AUTHORIZED AGENT A
<br />DE NUMBER
<br />YEAR
<br />MO
<br />DAY
<br />in.~.- COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference a%/attachments here)
<br />tt~.T3S E TOTAL IROd LIMITS YLLL dE fiAlYfj.O, ANO SETTLEADLE SOLIDS LI?1IT APPLIP,D
<br />f'~SSE6 I. A. L, PG IY, POR BFrdUI'8E!lYf1~i'':~Q82RL! SAMPLING.LlA.ST'ftUCTIO!JS-I.C.9, ,^;.
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<br />F~3 <=ICYR,24HF. PRF.CIP EYEt+T-
<br />XIII.
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<br />~~ ~`'~ EPA Form 3320-T (REV 3/99) Pre>{[ODS;l~ifio-'~a ply ; . SiSaEt~ .,, ` ~ `:{,,, ~ ~ , :+FC~ ~.; ,, ,~1~~.;+?.,' : ~~• THIS IS A 4-PART FORM PAGE OF
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