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PERMITTEE NAk*JADDRESS t7wd6& Far*iyNo-Wteeerisw I(Djsrws) NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES/ Form Approved <br />NAME DISCHARGE MONITORING REPORT (O R/ J F'. OMB No 2040'0004 <br />ADDRESS -JBR JC ) <br />1 STATE PERMIT NUMBER DISCHARGE NUMBER _ FINAL : II- <br />*_KER co 16 POND TO GOOD SPRING Ck <br />FACILITY _OWYO M NE MONITORING PERIOD <br />LOCATION _KER CO YEAR O DAY YEAR MO DAY <br />FROM TO <br />=Lt,Y D. SANDERS. VP OF NOTE: Reed Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, <br /> <br />EX FREOUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT '. J= <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 />NAMEfrInE PRINCIPAL EXECUTIVE OFFICER ' nn"y " r Pe"' ly ° Raw that this document and all atlarhmenb •rre <br />pmparsd under my dirxtlon or suprv6 on In amordence with ¦ "em designed <br /> <br />( <br />TELEPHONE <br />DATE <br /> to cure that qualified Personnel pr°perty gather and evaluate the Inforttatlon / <br />/ ? j/ /, <br />r submitted. Brad on my inquiry of the Anon or pnoro who manage the system, <br />t. a those Penn directly rw""!bk for gathering the Information, the Information -- <br />? <br />` <br />tL submitted ls, to the best of my knowledge and be lef, true, ncunir. and complete. <br />i <br />itk <br />t <br />I <br />t <br />f <br />f <br />SIGNATURE OF PRINCIPAL EXECUTIVE 1 = i J <br />• - J <br /> am aware that <br />gn <br />an <br />hen are s <br />Penalties <br />or ubmlttlng raise In <br />ormation, <br />TYPED OR PRINTED Including the possibility or fine and imprisonment for knowing vidauons. OFFICER OR AUTHORIZED AGENT CODE NUMflER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference aN artachments hers) <br />? <br />' <br />' D IF CLAIM APPRC? ti'YD r'v Wr)rD <br />RSCII <br />sR 1 <br />4!- <br />E VENT TS CLAIME <br />. . <br />-F-PEN IS I . A. 2. <br />. __ :ilti --"':F'i?L_ri •=_ Jt'T1 r <br />b <br />d i? ':? PAGE OF <br />e use <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may