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PERMITTEE NAME/ADDRESS ti.-hide Facilb)•.NamelLocafian rfDie.rnr) NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPOES) <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS <br />PERMIT NUMBER DISCHARGE NUMBER <br />FACILITY MONITORING PERIOD <br />LOCATION FROM YEAR MO DAY TO YEAR MO 4DAY <br />Form Approved. <br />OMB No. 2040.0004 <br />F - FINAL <br />PP2 TO SCULLION GULCH <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE r <br /> MEASUREMENT <br /> PERMIT x b it r x <br /> REQUIREMENT <br /> SAMPLE i <br /> MEASUREMENT <br /> PERMIT i• CL/ 3F• ;- <br /> REQUIREMENT <br />:T <br />Mt - <br /> <br />SAMPLE <br />SAMPLE <br /> MEASUREMENT <br /> PERMIT _.. •t....r. -- +41.:: ri-i-.- - i. ?r <br />;? r r L t.l)' V r 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 />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I ccnifs under penalty of Ina that this doeuntcnt and all attachments were <br /> <br />d <br />di <br />i <br />i <br />d <br />i <br />d <br />i <br />h <br />d <br />i <br />d <br />TELEPHONE <br />DATE <br /> prepate <br />un <br />er my <br />rect <br />on or %open <br />on to accor <br />ance w <br />a system <br />es <br />s <br />t <br />gne _ <br />- <br />- <br />/ <br />SI?? ??Gt•f t fT eS? to assure thin qualified personnel properly gather and evaluate the infomu+tion ---? ? <br />- <br />, submitted. Based on my inquiry of the person or person, who manage the system. <br /> or those pc7sons directly responsible for gathering the information, the information = ' - - <br />. submitted is, to the best of my knowledge :utd belief. true, accurate, and complete. <br />I am aware that there are significant penalties for submittin <br />false information SIGNATURE OF PRINCIPAL EXECUTIVE - •- ' - --' _ " <br /> <br />TYPED OF( PRINTED g <br />. <br />including the possibility of fine and imprisonment for knowing violations OFFICER OR AUTHORIZED AGENT AREA <br />CODE NUMBER <br />YEAR <br />MO <br />DAY <br />au aaaawnnc.na naa c? <br />EPA Form 3320-1 (Rev. 3199) Previous edftiors may be used. This is a .4,part fonn.