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PERMITTEE NAME/ADDRESS (include Facditt NanelLocation if UfJerenn NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS <br />PERMIT NUMBER DISCHARGE NUMBER <br />FACILITY ?p rIIIvE CUf?li..ir?. MONITORING PERIOD <br />LOCATION YEAR MO DAY YEAR MO DAY <br />i; ItN CO Biel FROM TO <br />i?Apn. RFrl AMAI'TON MANAGF^ <br />Form Approved. <br />OMB No. I40.0004 <br />F - FINAL RUU T T <br />DISCHARGE TO TRIB/FISH CREED, <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, <br /> <br />EX FREQUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />? <br />? <br />I <br />' <br /> MEASUREMENT <br />; \ <br />- <br />-_ •-? <br /> PERMIT :- , ?. .. <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT - <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />E <br />S <br />RE <br />E <br />T <br />( _ <br /> M <br />A <br />U <br />M <br />N - <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE - - " <br /> MEASUREMENT <br /> PERMIT ' <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT f V ! <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER I rertif> under penalty of law that this document and all attwhmrnt%weer <br />prepared under mt direction or wperkion in accordance with a system designed 1 TELEPHONE DATE <br /> to aswrr that quailfied perwnnel property gather and essluate the information <br /> suhmitted. Based on m? inquin of the per.un or persons who manage they stem, <br /> or those penons dirrcd? respomihk for gathering the Information, the information <br /> suhmilird Is, to the hrsl of m> knowledge and belief. true, accurate, and crmplete. <br /> I am aaarr that Ihrrc jr, •igr ifitant <br />enahics for uhmillin <br />false information SIG <br />URE OF PRINCIPAL EXECUTIVE 1 ' <br />TYPED OR PRINTED p <br />, <br />g <br />au ludmg the p -itahl% ..f fine and impri• in-t fur knowing si daliuns N <br />OF ICER OR AUTHORIZED AGENT AREA NUMBER YEAR MO DAY <br />GOMMENT5 ANU tArLAMAIIVIV Ur ANT VIULAIIVN.J llYerefence art arracnments nerej <br />'EC <br />EPA Form 3320.1 (Rev. 3199) Previous edrti m may be used. ="-' '4q