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PERMITTEE NAME/ADDRESS(7."F«-urryx..?L«.,,.I/DCor.0 <br />NAME <br />ADDRESS <br />LUX <br />:I::RSET CI <br />FACILITY 3ORN CRK & --.PK MII <br />LOCATION `-ERSET Ci <br />1IES T. COOPER. EXEC V. <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM /rNPOESf <br />DISCHARGE MONITORING REPORT (DAR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />B <br />ES MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO ? I - I I <br />p <br />Form Approved . <br />OMB No. 2040-0004 <br />MINOR <br />(SUBR MH) <br />F - FINAL <br />SURF RUNOFF <br />? )(. i <br />NOTE: Read instructiom Wore completing this form. <br />)NIS <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY <br />SAMPLE <br /> Or <br /> EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT 6- S <br /> REQUIREMENT <br />D- T `i.. SAMPLE <br />PENDED MEASUREMENT <br /> <br /> PERMIT + rs? =#: 3[ >r•`rt <br /> REQUIREMENT 3 OD A H'4'ia !?iq i } <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT *#ikilh# ##s+it#iE k ##4F 3t t :i 7,l. <br /> REQUIREMENT )!;'A t?V(7 Gi y !` ON Ff <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT as?r# =-.: : +?tb it#iF#iEtr IUU i• . <br /> REQUIREMENT --Tjo? AVC, bA i i. `! MV I0!, <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT t.* ; .. i <br /> REQUIREMENT <br /> SAMPLE <br />ttri 1`1:.! MEASUREMENT <br /> <br />50 O 0 PERMIT r - <br />__UEN7 REQUIREMENT <br />H SAMPLE <br />s •t,.. MEASUREMENT <br /> <br /> PERMIT - , <br /> REQUIREMENT <br />NAME/TfTLE PRINCIPAL EXECUTIVE OFFICER ' crrt'ty under Pen' ty ° Iaw that Ihh do nwnt and aB attachments wer TELEPHONE DATE <br /> PRP•Rd and" my dlreclton or snperrttton In accordance with a system designed <br /> to sere that quaBMd personnel properly gather and evaluate the Int°rmatbn <br /> s.bmined. Based on my inquiry of the person or Persona who manage the system, <br />o <br />th <br />dbk f <br />di <br />tl <br />y <br />' r <br />ose perms <br />rec <br />y resper <br />or gathering the Information, the Into.,. all" <br />r submilted b, to the best or my knowledge and belief. trua, accurate. and mmplele. <br /> I am aware that Iher art significant Pension Ior sabmllttng fain Information SIGNATURE OF PRINCIPAL EXECUTIVE <br />TYPED OR PRINTED . <br />Including the pondbluty o(nne and Imprisonment roe knowing aolatl n OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />GUMMtN I S Aryb EXr-L^rA 11vni yr Ara T vlvLn 1 Iona rnayoronce an srracnrr»nrs nere/ <br /> i_.FAT??_E SGt._TD i_-M T AP°I ?FS r-nR 7-10YR, 7 4 H R PPFC"TP F 1)--N <br /> <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. This is a 4-part Corm. PAGE OF