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PERMITTEE NAME)ADDRESS(7neYirFacfnryNw?L«arsaw(/Dtp,.w) NATIONAL POLLUTANT DISCHARGE EUMINATION 5r$Tem /NPOES) <br />NAME O DISCHARGE MONITORING REPORT /DMR) <br />ADDRESS vac ?i <br />_ L' u t vv PERMIT NUMBER DISCHARGE NUMDER <br />FACILITY J I ENO. _ ?G O ?OUOn' MONITORING PERIOD <br />A <br />LOCATION , O N I A P 0 O S Y O D 4 Y O D <br />??g\o \ a d gM FROM TO <br />. ;ILLIAM A. BEAR JR. M.t('?i???9 <br />MINOR <br />(SUBR MH ) <br />F - FINAL DELTA <br />SR/MINE WTR TO DEER TRAIL_ OTCH <br />NOTE: Read Instructions Wore complath?0 this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, <br /> <br />EX FREOUq+cr <br />Of SAMPLE <br /> <br />TYPE <br /> ANALrsrs <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE s; tt a <br /> MEASUREMENT <br /> PERMIT . 5 ###it## 9.0 , <br /> REQUIREMENT MINIMUM MAXIMUM <br /> <br /> SAMPLE <br />'R EN+-' MEASUREMENT <br />i1G _O PERMIT 70 <br />!=F1 i_ REQUIREMENT DA AVG i:r;i'---' ;X MONTH <br />l t - SAMPLE <br /> MEASUREMENT <br />U` t PERMIT R. C d <br /> REQUIREMENT 30DA AVG GAILY MX <br />MONTH <br /> SAMPLE <br /> MEASUREMENT <br />I C) PERMIT 6000 <br />!..NT GRC)!- REQUIREMENT 30DA AV)G DAILY NX MONTH <br /> SAMPLE <br /> MEASUREMENT <br />,-,2 1 0 PERMIT it <br />;H-NT GRO`.- REQUIREMENT ..;T MAX <br />- SAMPLE i <br />I R EA TMENT F114' MEASUREMENT <br />r, 1 0 0 PERMIT ;r <br />r;_ ;'RUC".• '. REQUIREMENT i .LS' MX <br />_ SAMPLE <br /> MEASUREMENT <br /> <br />PERMIT <br />REQUIREMENT QRTR AVG GRTR MAX <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER 1 nn"r "d" pansly o Isw that tee document and all sttachmenu ware TELEPHONE DATE <br />prepared tender my direction or mpervision in accordance with a system ddtned <br />to assure that gu@Afted personnel properly gather and evaluate the Ininrmation <br />sabadtled. named on my Inquiry or the pes or persons who mans=r the snirm, <br />\ r <br />or those persons directly responsible for tathering the Inlorfnatlew, the Inrormalton <br />? <br />t <br />f <br />k <br />b <br />I <br />th <br />b <br />t <br />d <br />my <br />now <br />milted <br />s, to <br />e <br />es <br />o <br />r <br />su <br />te and belief, true. s rstr. and complete. <br />I am swam that there are sltNfloM <br />enaltles for mbMttin <br />false Informati <br />SIGNATURE OF PRINCI?AL EXECUTIVE <br /> p <br />t <br />on. <br />TYPED OR PRINTED including the podblllty of ens and ImprlsonmrM for bnowlnt .1ols0ons. OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments hard) <br />24HR PRECIP EVENT IS CLAIMED. IF CLAIM APPROVED. 13'-( <br />hti?C?1, <br />t{ TED MEASUREMENTS-SEE I. A - 4-S F (=; ? L i:= t•i OF [,Ps •rli= <br />ter _ - -I. ?l. 1, :3 HG Y_ ?TRLY SAMPLING INSTR .;,TIONS a; f'ts :Q <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. (T%9.iS'' Q•4-08rf. Corm, PAGE OF <br />Form Approved <br />1\T JILT -'ll <br />OMB No. 2040-0004