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<br />PLDTIty NLInE/LDn~IJJatnq DISCHARG "~DNITORING REPORT /DMRI ~ ~~.~L
<br />~MS_rnt ;,~~~Af'" C'n MDA~_______ 116" 1719 rINOR Form Approved
<br />woDR[nrnlnuY~~j~________ (SUER NW) h®NIR1'No. 2oao-oooa
<br />~__S]~) STITR HTC.ILNAY_l~_____- PERMIT NUMNR w.cNAwcL nvxeLn F - FINAL EXpIrBS 9-Sa-91
<br />-'--I'S`~''~---------~'~-~'~L'- MONITORING PERIOD GULCR A SF,DI POND/GOOD SPGS CR
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<br />NAM!/TITLE 1 IP OFFICER I C[RrRY uNDEn PFNALrY a LAw TrvAr r NAVE PEReOIIALLY FLAYINED
<br />AND AY FAMILIAR MTN THE INFORMATION SUBMITTED NER[IN
<br />AND BASED TELEPHONE D A T [
<br /> .
<br />ON MY IMD11gY OF TNOeE INdVIWAlS IMMEDIAT[LV nESPONSIeLE FOR .
<br />HSEQ & LAND MANAGER °~`"'""" T"` '"F°""""°~" r eELKVE THE SUBMITTED INFORMATIDN
<br />le TRUE. AccDR,TE AND CDMALETE I AY AWARE THAT TN[gE AItE sIG
<br />970.8244451:
<br />•
<br />S 0 4 0
<br /> hIFICANT PENALTIES TOR SUHLITfING FALSE INFCRMATERI IryCLULrNG
<br />TNF POSvIerL ITV OE FWE AND IMPR50NMENT SEE IB USC ~ 1001 AND
<br />]]uSC ~ I]I9 IR,MhR. undo Ib- u"mN. ,na. ,nrldr /md Ay u. FIR Y.r
<br />T l~
<br />[IONATURE OF PRINCIPAL E%ECUTIVE
<br />TYPED OR PRINT[D A,dn, ~IMa~mu,n lmOnvmm~ll n/MIPwn FwnnlA. and .S .nn, OFFICER OR AUTHORIZED AGENT NUMBER YEAR MO [
<br />COM M[NT AND E%PLANATION OF ANY VIOLATIONS (Re7rrtwre all ullurhnfenlE heir)
<br />SETTLEABLP. SOLIDS LIMTT APPLIES ONLY IP <~ IG-YR, 24-AR PRP.CIP £YENT IS CLAIhEDL IP CLAIB APPROYED'BY
<br />M~CD, TSy E IRON LIMITS PILL NOT BE APPLIED TO REPORTED MEASUk°HENTS--SEE I.A. LA, PG rt AND I.B.1D, PG E
<br />T n a ' (R[-LAC[[ [-w rowM T-LO wNlcN MAY NOT H[ u[[D.1 •wo[ D•
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