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PERMITTEE NAMEMDDRESS(7whk)raeWyNawWLx.wi-(/A(Owwr) <br />NAME <br />ADDRESS <br />_r:KER L <br />FACILITY _?; OWYO 't ' • - <br />LOCATION =KER ip <br />? <br />:ILLY D. SANDERS, ?/f r' <br />NATIONAL POLLUTANT DISCHAAGE ELIMINATION SYSTEM INPOESI <br />DISCHARGE MONITORING REPORT (O R) <br />PERMIT NUMBER DISCHMGE NUMBER <br />L r. <br />MONITORING PERIOD <br />YEAR. MO DAY YEAR MO DAY <br />OF - FROM TO <br />Form Approved <br />M I 1%10r: ONI No 2040-0004 <br />( SUE` <br />F - F i NAL ;L <br />PROSPECT 5ED PD/GOOD SPRING CR <br />NOTE: Read Instructions boforo completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY SAMPLE <br /> <br />EX OF <br /> ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />- SAMPLE <br />I <br /> MEASUREMENT i <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />SAMPLE <br />MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />1 crud; -.n-j r Pena ly o law that thb document and an altarhmentr were NAMElTiTLE PRINCIPAL EXECUTIVE OFFICER <br />TELEPHONE <br />I <br />I <br />d <br />d <br />i <br />i <br />t DATE <br />E <br />Prepare <br />er my d <br />un <br />rect <br />on or oup. <br />on <br />n arrordancr with a sys <br />em dedgned <br />to assure that <br />uallned <br />ersonnel <br />ro <br />erl <br />ather and.,Wu <br />the Info <br />l <br />ati -J <br />o <br />P <br />p <br />y g <br />P <br />a <br />e <br />rm <br />on ? /? ?? / <br />I j F <br />i <br />i <br />f th <br />b <br />B <br />d I / <br />1 <br />nqu <br />mllled. <br />re <br />"my <br />ry o <br />e penoo or prevom who manage On e" m* <br />. ao <br />or those prraor directly reperdb4 for gsthering the Inforwutlow, the information <br />:, r.- <br /> <br />wW <br />W th <br />b <br />t <br />L <br />iMf <br />I <br />v <br />E <br />lll <br />d h <br />f <br />d b <br />f <br />(? J <br />ge an <br />e <br />o <br />my <br />ne <br />w <br />m <br />e <br />, <br />e <br />c <br />. <br />rw. aravra <br />e. and tornp4le. <br />SIONATVRE OF /RINCWAL EXECUTIVE I <br />t / <br />d <br />dn <br />t <br />f <br /> f ¦m aware that th- are <br />g <br />ran <br />Penalties W robm <br />tnng rater Inrorn.tion. AIFA <br />TYPED OR PRINTED fnrfuding the pwolbility of nm and Imprisonment for knowing eiolatf OFFICER OR AUTHORIZED AGENT NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Ro/oronctraA attachments her*] <br />_4HR PR1=C T° EVENT IS CLAIMED. IF CLAIM APPROVED B',' WQCD! <br />ME-rNTs - SEE i. A. -- <br />;? Ri_'r ".ING INSTRUCTIONS - _ i <br />I- f <br />EPA Form 3320-1 (Rev V99) Previous editions may be used orm. PAGE OF