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FERMITTEE NAMEJADDRESS17..6.&Fwot,,N..srL.r.el..ttD(I .w,) <br />NAME <br />ADDRESS <br />13ii- r 5Jb <br />RSE T CI <br />FACILITY 'DRN CRK & ELK •--Rte IND <br />LOCATION -RSET CS <br />ES T COOPER, C V. <br />NATIONAL POLLVTANT OISCHAAOE ELIMINATION SYSTEM NPOES) <br />DISCHARGE MONITORING REPORT JD R) <br />PERMIT NUMBER aSCHAROE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Appro.ea <br />MII1' - ova r,a oao-coon <br />F - Fi <br />SURF ""'Cr- ii1jrv,Ljr I i U <br />NOTE: Read Instructions bafora completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO fREOUENCY SAMPLE <br /> 1>< OF <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT #G; ' <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT r' <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 /> <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT » s F <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br />NAME/TiTLE PRINCIPAL EXECUTIVE OFFICER I `er"y mnd" Prn y o bw that Uw document and all at1whatants wen <br />TELEPHONE <br />DATE <br /> prepared under my directbn or .rperHflort In atcordsnce with • system darned <br /> <br />- r le inure that qushlled Personnel properly lather and evaluate the Irtformatlon <br />submitted. Based on m I ul of the <br />7 n9 7 Mrson or persoro who malta <br />e the f <br />lr - <br />. s <br />]s <br />m, <br />or tho <br />dlre <br />t <br />o <br />Ibl <br />f <br /> se p""m <br />e <br />y mp <br />e <br />RS <br />or rathertng the Infornfation, the Information , <br />• ;/ ' / mbmltled Is, to the bert of my ?nowledte and beW, 1r . accurste, and co plate. I am swan that then art d914fieant panattla for mbmltMq raise Information, SIGNATURE OF PRINCNAL <br /> EXECUTFVE <br />TYPED OR PRINTED InehWing the possibility of nne and Impedonmrni for knowing rfots0orts. OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANT VIULA FIONS (Reforonce aft attachmonta hors) - <br />413L-E SOL.T_DS LMT APPLTFf) FOR -t n, ??E-IR PRFCTP ? ':F <br />"JT-SEE <br />- y H i ;'.. <br />EPA Form 3320-1 (Rev 3199) Previous edibons may be used TtUS`.1S.8 4-part forth PAGE OF