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1'ERMtTTEE NAME/ADDRESS pweh~. iwiMC•N../Lerr>aw {/DV)6.w1 NATIONK POLLUTANT d5CHM0E ELIMINATON SY ST pN /Il~/~E$1
<br />NAME DISCHARGE MONITORING REPORT (DMRI
<br />ADDRESS ~ i .; ~ _.'. ;.,;
<br />F'. O. BOX 53` PERMIT NUMBER ascHAnoEwuMeta
<br />MONITORING PERIOD
<br />FACtItTY •iBORN CRK ~. SLY, CRK t'lli~-'~~ YEAR M0. DA Y R MO D
<br />LOCATION ''iERSET C! ' '% ~ -"* FROM TO
<br />-MMES T COOPER, EXEC V. ~'.
<br />Form Approved.
<br />OMB No. 2040-000
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<br />SURF Rti~a~~r L i v iii. i= h ~ijia ~ _~ i? i `Y
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<br />NOTE: R~~d k+~taucNa» I»fara compbtinq thh fam.
<br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION rJO, FREQUENCY
<br />of SAMPLE
<br /> EX TYPE
<br /> ANA~rsts
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS
<br /> SAMPLE f - - .- - ,
<br /> MEASUREMENT
<br /> PERMIT ~ x I- '
<br />. U~:~ ~ ~rtu~'.: REQUIREMENT MINIr1U~; MHXIMUM r'~OPdT;
<br />_ - ~ L ~ SAMPLE
<br />~' "~i'END1`i MEASUREMENT
<br />•G 1 .. PERMIT .. , - .~_.
<br />'!EN i GR.U~;~ V:' •, REQUIREMENT 30Gfi k`JC; DAILY MX '"s•.' _ t',Clr,; T(':
<br />a .~~ .:~.,, SAMPLE .-_
<br /> MEASUREMENT
<br />1 ~ PERMIT ,.~ , ~ _ . I', ,. t_.. s
<br />' ~ GRO~_ REQUIREMENT ~ ^ ~ -~'1[ff~ AVG I1(-i I LY t iX .. ('f ~it'a ; i•
<br /> SAMPLE ~,~ ;
<br />riS i MEASUREMENT
<br />S 1 C' PERMIT ~ ~ ~; ~: ~ ~ . - ~ , r-~
<br />-. UEN7 GRU::' • • REQUIREMENT OaI)A k`.jG i3F~ILY i ;X ~•.'~: - ._ riONT
<br />~ : _ ....- SAMPLE <:
<br /> MEASUREMENT
<br />~2 1 d :i PERMIT - r •, ~ -~ _ ~ - ... .. ..~ : 1 , t r~ ~~
<br />~_UENT GR05~_ •'~~• REQUIREMENT It•IST i-ikF. ~>>riv7
<br />- - - SAMPLE _ ..,
<br />±I~:~_~ `i-r7FkTMENT PL.• MEASUREMENT
<br />.iiO=,G 1 (~ G PERMIT ... o- n -;r ;~ : r. ...
<br />' FFLUENT GROSS Vr""~~ REQUIREMENT ~3'7D'F- r. ~'• ILY I'1 Y. ~ %~'
<br />~' ' SAMPLE ~ `
<br />' ~ ~_',' , MEASUREMENT
<br />- - PERMIT ~ .' _ - .. -, ,. -~ . ,. , ., . . ,. ,. ..
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<br />NAMERiTIE PRINCIPAL EXECUTIVE OFFICER ' """~ " rr °'""r °r''"'"" `~" °ironi"""di0 ""`'""""' °"` TELEPHONE DATE
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<br />/ti1oNATURE OF t~RtNC1IAl EXECUTIVE
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<br />ER OR AUTHORIZED AGENT A A
<br />NUMBER YEAR MO DAY
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<br />COMMENTS AND EXPLANATION OF ANr vtvlAllvNS /RIfMIrIC1 N-~rncnmenre n~r~l
<br />6:.(l ,1 E 6)A I `IE 1.', r'ti' :' ~ I_EADLF SOLIDS LMT APPLIES FOR C=1 OYR ~ 24HR PREC I P E~JENT;
<br />r'1F,. _ - ;~~~ 1~ F(~(_ .. ~_-;~;,. t=VERT-SE1= ~ P(' 4-5 .. `'4MNT5.
<br />EPA Form 3320-1 (Rev. 399) Previous editions may be used ,:1 `; 7,,~,~ ; ~ Tt?tS /S.t! 4-PBfF fRrn1. PAGE OF
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