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Form Approved. <br />P£RMITTEE NAME/ADDiiESS p~yf«•w4 N~rrLerwt^' (IDIS^^") NATIfXI HL POLLUTANT OISCMMOE ELIMINATION 5YSTEbi (NPDESI OMB ND' ZO~aO~Oa <br />DISCHARGE MONITORING REPORT IDMR/ <br />NAME <br />ADDRESS ~ <br />PERMIT NUMBER ascHAnaE NUMBER ~',if~l_ <br />FACILETY ~RiJ CR4t ><c EL.K CRK MIPJ: ~ MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY , <br />LOG-T1oN '':SST CJ FROM TO <br />T r' flr 1° t= R t EXEC V. ~ ' NOTE: Rud kwtrvctlorn bstofs complsth-p this fwm. <br />PAR <br />METER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ, FREQUENCY <br />OF SAMPLE <br />A EX TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ANAa.rsls <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT ~ ~ ~ ~: <br /> REQUIREMENT ' <br /> SAMPLE <br /> MEASUREMENT <br /> <br />`•' PERMIT ' <br /> REQUIREMENT ' " ' <br /> SAMPLE <br /> MEASUREMENT <br /> , <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br />PERMIT .. <br /> <br />~~ i <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ <br />t _ <br /> REQUIREMENT ' ' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ _. <br /> REQUIREMENT . <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />RErUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER t Kr11i) Y er pen. y o ^~ u.t ule dntament •nd .u enabnenb Mere TELEPHONE <br />prep.red Yoder inf dlre•ctbn or fupenltfon In rcord.ntt wllb ^ .Trtem ddprd DATE <br />to YYYYrs tbYl ~YYMfkd personnel propeAf ~YtMr end tr YlvYle IM Infnrnrtlon <br />Yobrtrtted. eyed Yn mf Inquiry of tM prnat or per~ont .M m.ngt tM r7etem, <br />or 1Mee prnors dlrectlf resperdbk fa ~YtbeA~ IAe Infonrutlow, IM InformYllon <br />l <br />-' <br />submitted b. to the belt of m7 kYewYd~e ^nd beeef, INt, YtcYntr, Yr1d tomple <br />e. <br />I <br />NATl1RE OF -AINC7/AL El(ECtlTEVE <br /> 1 Ym ^reYrs uYt there ere sl~dfkant penYitlo ter sYbmltt)n~ hbe InformYtlen, e <br />O S NUMBER <br />C YEAR MO DAY <br />TYPE ~ PRN'ITl'D Inrludlnt IM podbiNtf of Ilnr Ynd Imprisonment fa kno•Inf .IYIYtIORi OFFICER OR AUTHORIZED AGENT OO <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS IR•1•rmc• •h •rbchm•ntJ h•i•/ _~; ~ ~~C'rl 'l n~ I_t'1 f APPLIED F't7R <~ = 1'"tt"p . :'4HFZ NR~C: I P Ft'ENT; <br />This is a 4-part form. PAGE OF <br />EPA Form 3320-1 (Rev. 31991 Previous editions may be used. <br />