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PERMITTEE NAME/ADDRESS (7neylrieeNryNea?Ler?rt.n (/nIQil..nq NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM /NPDES) Form Approved <br />NAME DISCHARGE MONITORING REPORT (DMR) =? OMB No 2040-0004 <br />ADDRESS v . <br />' ? 1 STATE H I GHWP PERMIT NUMBER DISCHARGE NUMBER !JAL ML <br />EKEft .,-OR POND TO TAYLOi' CRE1`a-. <br />FACILITY _.OWYO I" i NE MONITORING PERIOD <br />YEAR MO DAY <br />LOCATION :.KER YEAR MO DAY TO <br />t- "'• - / ` ?.t_ LY )a AND1=t; O X31: FROM IDPS NOTE: Read inebuctlom b*fore completing thle form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREOUENCY SAMPLE <br /> <br />EX OF <br /> ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE :.. - <br /> MEASUREMENT <br /> PERMIT _ <br />_ I_ REQUIREMENT <br /> <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 «rtilr r er Pen. If a .w th.I thh document nd .11 .11whment' were <br />NAME/T1TLE PRINCIP L EXECUTIVE OFFICER TELEPHONE <br />s <br />1. <br />DATE <br />prep.red co <br />ec mf elrertlon a super?l/on In .ccord.nce Ruh ..fs1.m sdpnee <br />/ <br />? <br />V , t. /?re that 1u.tln.d pcn mmrl PrepeAf L.tMr.nd e.Nu.le the Inrmm.Iton <br />" wrbrrrlled. B..ee on my Inpulry of Ih. perwn m p.rsom who m 31" the ryrtem <br />'- P-1 <br />e <br />` <br />. <br />•? <br />J? <br />/ V J 1 <br />those Penore dlr tlf MPadbk for t.th.Anf th. Informottolt. the Inf.r ,ten <br />i_.?-?L' =,l ! j - •J <br />to the bet or m <br />kmwkd <br />- <br />fir; j <br />s <br />b <br />itt <br />d b <br />M b <br />ll <br />I <br />f <br />' <br />( <br />t <br />d <br />l <br />-.. <br />7 <br />( ?,? /?k".='. •?, <br />. <br />. <br />u <br />m <br />e <br />, <br />Ee . <br />e <br />. <br />rw. K"ni <br />e. en <br />' j. <br />e <br />compk <br />e_ <br />Y? I .+n .w.re th.I there .re et <br />dttum <br />en.ltle fo <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />brNltln <br />hbe Inf <br />n+ <br />n <br /> p <br />P <br />r w <br />E <br />er <br />. <br />en. <br />TYPED OR PRINTED tnrhed.nl the pnatbntty of n- eml ImpAwwment for kno.Ing rk stj n OFFICER OR AUTHORIZED AGENT COOS NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all •ttechments here! <br />r- 1R P1.RF('IP EVFNT IS CLAIMED. IF' CLAIM APPROV-D SY IAGC'- SEE I. A. 2, FIG. 3 Fr <br />:,. TNic.7RLtk'TIONS - I C. 1 <br />EPA Form 3320-1 (Rev 3/99) Previous editions may be used i , . , TUSfi~ 464-part torln. PAGE OF