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PERMITTEE NAME/ADDRESS ilnclude FaciGh \nmt/hwati n: if Niffercntt <br />NAME <br />ADDRESS <br />I:wOOD CO St <br />FACILITY n M IV!E <br />LOCATION r P EFK co W <br />'JF I EACH. t-R FPJV FNf:TNFF <br />Form Approved. <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) OMB No. 2040-0004 <br />DISCHARGE MONITORING REPORT (OMR) <br />Jr ? <br />' PERMIT NUMBER DISCHARGE NUMBER PEAL ROUTI <br />?1 1 MONITORING PERIOD E RUNOFF TO TROUT CREEK <br />FROM YEAR MO DAY TO YEAR MO DAY <br />14•f: <br />rR NOTE: Read 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 /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ANALYSIS <br /> SAMPLE <br />MEASUREMENT ? -• c •-. <br />r= ) ? ? 1 ?' ?. Ln? '- <br /> PERMIT - ,,? - <br /> REQUIREMENT ^(; <br /> SAMPLE <br />MEASUREMENT <br /> PERMIT 77 t_ c i`+._ <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 />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER I artir, under penalty or law that this document and all atmchmsnts were TELEPHONE <br />prepared under my direction or sup Won in accurdance with a system designrd DATE <br /> <br />r? `l to assun• that yurtiritvl perumnrl prtpe rl, galhrr am! esuhmte the information <br />submitted. Nried on m% inyuin of the prrsnn or perwms who manalir the sv%trm. <br /> or Ihosr prn.xts direrdy rr. p.m.ildc• for Kathrrintt the information, the Inrnrmalion t` <br /> <br />- submitl d is, to the first or m. knowledge and helieL true. a,w ante and nanplar. <br /> <br />I am aware mot there are signirknet penalties for whmttting rats, iaroraua6on. <br /> <br />SIGNATURE OF PRINCIPAL EXECUTIVE y <br />r <br />- ' ) I <br /> <br />V• <br /> <br />, <br /> <br />/ <br />TYPED OR PRINTED including the pe-lhilitq of nine and Impriv nin"I for knowing violations. OFFICER OR AUTHORIZED AGENT AREA NUMBER YEAR MO DAY <br />lrsa.ar-- an at gal..... otica ,ta,al <br />E I. A. 2, PG. 4 FOR REQUIREMENTS <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be Used. 00064: '_ThMs a 4-girt.form.