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Form Approved <br />p£RMITTEE NAME/AODRESSpwcMr F.rWryN../Gerrlenr/D(Qi..nq NATIONAL FOLL'JTANT OiSCHAAOF EIIMINAiICN SYSTEM /NPDESI GMB tb 03C-000a <br />NAME DISCHARGE MONITORING REPORT (OMR/ •.; };- ~ <br />ADDRESS lei;-t'•i '.. !':~1 _ c.LY. _RY~ {`i i i~.; `~IJuh: ~. <br />$ 0 k 53 S PERMIT NUMBER ascl+AAaE NuMeE>t - I` ', <br />MONITORING PERIOD <br />FACILITY ':OpN CRK $:. ELK CP,K MIL`:' YEAR MO DAY YEAR MO DAY <br />LOCATION RSET FROM TO <br />'1ES T. COOPER, EXEC ~ NOTE: R~~d IfwdveNw» b~fa~ compbth-p thb form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ, FAEOUEHCV SAMPLE <br /> <br />EX OF <br />YP <br /> ANAtrsls T <br />E <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT .. t -z 1., r, . ~ , .;-##•# 9 . Q __ I !'~' ` <br /> REOUIREMENT •~~--.; ~ MINZ:~~~.~r~~ MaxIrtur~: ..~~.;-r, <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~r~-~3z-x-sr -. ~~~;r:~ ; ;_ .--r ,. <br /> REQUIREMENT _ _; i'N A'JG f 1! 'G rHV 1 '~ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT :. ~.>:.': #'.t~k. iF:f###-~~ G ~! ,_ <br /> REQUIREMENT 3GiJA r~4'(:: DF4I i_Y .'. ;{ i~li:ii~i ' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ### ~ -.. ,. ###at lt',r ###3F~!•# ,~ , _.;;••1 ~ J : - -,:~ <br /> REQUIREMENT IN`;'f '•~=;'< G~=~•~ r <br /> SAMPLE <br />;~ F_ri 1~P„-. ~ - MEASUREMENT <br />.n ~ Q PERMIT 1-' h , -: ~ ~, si .. =.t ., y.~~ ?rx .. r (L. 4.! 1 c,i• <br />:R(]E. REQUIREMENT iiAl `'~ h9X '-i(]h;~ !-. <br />.~ ~ ~ SAMPLE <br /> MEASUREMENT <br />n <br />Pig' PERMIT <br />REOUIREMENT _ <br />= <br />iT MAX ,.. , _ , . _ , <br />.; : ;; •, <br />~ <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER ~ nn~ry • «pen• 1) 0 1•w u•t lbb davmrnl .ne •u ut.chmenU were TELEPHONE DATE <br />pnp•nM under T~ directbn w wper.l~on In .ccad.nre with . totem de~~ned <br />-f _ to r~R Ihet ~uNlneO prrwnnH prow+(f tether end erelu.le the Inroem^llon _ - . <br />- tabmllled <br />Stwd on m~ Inqulr7 of the prrwn a pertero who m^n. <br />t the . <br />tem <br />~ <br />~ <br />~ <br />. <br />j <br />s <br />. <br />~ <br />. <br />~ <br />/ <br />Nl <br />e~eltNe ! <br />w IM <br />dlr <br />re <br />Ih <br />rl <br />I <br />tl <br />th <br />l <br />U <br />f <br />I <br />f <br />~ -~ ~ ' <br />u perms <br />e <br />~ <br />p <br />oe ~• <br />e <br />n~ <br />te <br />n <br />ernu <br />ow, <br />_ <br />e <br />n <br />erm.l <br />on <br />T <br />/ 1 ~ ~ C : <br />~ 1 wA <br />lued I <br />b <br />lt of mr kne..kd <br />t <br />th <br />d E <br />h <br />t <br />~ <br />f <br />I <br />d <br />kl 1 <br />- <br />_ <br />m <br />s. <br />o <br />e <br />e <br />p u <br />e <br />e <br />. <br />rw. .ccvn <br />e. •n <br />~ <br />[omp <br />c <br />' 1 •m •were th.l (here •R dpJlkant pmMtfv ror abmlltlr <br />; ~ iIONATURE Of /RINC1-AL EXECIlTfVE <br />fLLee Inforrnatbn <br /> K <br />. <br />TMpEp OR PRINTED Inchdln~ Abe posdDluy w floe •nd Imprisonment fw lno.ln~ .1d^uan OFFFCER OR AUTHORIZED AGENT CODE NVMBER YEAR MO DAY <br />COMMENTS AND EXPLANAT1vN c>r ~nr vlvl.n r wn5 Ifr~i~rtrnc• sn •rr~cnmmr: n~r~l <br />EPA Form 3320-1 (Rev, 3/~) Previous editions may be used <br />D. OiL & GREASE - SFF I Li. i <br />-Fins IIS a a-part form. <br />