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rERMI TEE NAMEIADDRESS (1-" F.rIMry Naa.?Leeare? IJDIQIrrwu? NATIONAL POLLUTANT 04SCHMOE ELIMINATION SYSTEM (NPDESf <br />NAME DISCI4ARGE MONITORING REPORT (DMR) <br />ADDRESS <br />PERMIT NUMBER DISCHARGE NUMBER <br />SET <br />FACILrTY iJORN CRK FlL CR!C MONITORING PERIOD <br />LOCATION , !ERSET ; s- Y R MO DAY YE A MO D Y <br />FROM TO <br />.•,MES T COOPER, EXEC <br />Form Approved <br />MINOR OMB No 2040-W <br />(SUBR 11H) e <br />F - F I NAL = <br />SURFACE RUN05F TO HUBDARD CRI, <br />NOTE: Read kwtructlone before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. <br /> <br />EX FnEGt>fNCY <br />or. SAMPLE <br /> <br />TYPE <br /> >< ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> <br />SAMPLE - 4* <br />4#3 <br />7, <br />° ' . <br /> MEASUREMENT <br /> PERMIT <br />'Jc_iWT i L3 i3 'v ALUE REQUIREMENT = N I N MUM MAX I MUN MONTH <br />! ,._ SAMPLE Y. :, .. <br />ENDED MEASUREMENT <br />, <br />:. 0 1 C: J PERMIT 17 in" <br />L JF ri r 'F2 0G S V : <br />REQUIREMENT <br /> <br />-- <br /> <br />r <br />- <br />:371)A 1? <br />I"1 J riV IC ^:T I <br /> SAMPLE ? <br /> MEASUREMENT <br /> PERMIT <br />VENT C7R0' REQUIREMENT ?0DA A, I L Y r-l MCTITr <br />t_a L. SAMPLE <br />AS E r' MEASUREMENT _ <br />f G PERMIT -? .... : _ _ <br />^v f GROG -i L_ REQUIREMENT <br />--- -- ;SODA FW(1 ;AILY MX MONTH <br />- <br />_ ?. r,. SAMPLE <br /> MEASUREMENT <br />L 0 0 PERMIT <br />- is r LUFNT GROSS VALUE REQUIREMENT <br />_ , . SAMPLE <br />TREATMENT PLAW MEASUREMENT <br /> - <br /> <br />0 1 0 O <br />PERMIT <br />p? ff .. : > <br />;BOSS VALU : REQUIREMENT 30DA AVG DAILY MX <br />:; .t.. SAMPLE <br /> MEASUREMENT <br />? <br />1 <br />i Al ?t <br />.4 <br />PERMIT Ri?t <br />REQUIREMENT _ r f <br />NAMEmnE PRINCIP L EXECUTIVE OFFICER I mnli) , r pen, tr o l,.ihat this dncumenl and ¦11 attachments wem <br />TELEPHONE <br />prepared under my elrerrton or superHsion to .ccord.nm with . sys,em earned <br />DATE <br />In mum that qu,Nned personnel propeA7 Ether and es,lu,te the Infonnatlon <br />submlltrd. Bard on ms Inquiry of the person « p,n who manage the rrffem <br />, <br />, ?I <br />, <br />? <br />- • <br />' <br />?1 <br />f' or Ihosr prnorss directly refporetlDM for gathering the Infortrutlow, the Infprmallnn ? <br />, ,. I ; <br />_- <br />b <br />r <br />f <br />l <br />D <br />l <br />d <br />d <br />l <br />' <br />- t <br />' <br />fi <br />V ` ? ?,, T <br />% ? <br />/ <br />me <br />"ar <br />r <br />, Ime, attvrs <br />+ Atbmrlled h, to the <br />eft o <br />e <br />ge an <br />De <br />e, and comp <br />ete. <br />? <br />J ( <br />i <br />SIGNATURE OF PAINCWAL EXECUTIVE <br />l <br />N <br />l <br />I <br />f <br />- <br /> g <br />tam •wam that then am s <br />nnnt pendfks for subm <br />lfing Pale <br />n <br />nrmallon. A AEA <br />TYPED OR PRINTED Inchding the pofalbtuty of nne and tmprfonrnrnt rw ?noring .Id,tlwti OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference ell attachments herd <br />) <br />I <br />,• - :_EAr3LE SCLT?)S I- _MT A°°LTFL FOR "=10, ?4f!P PRFCIP 174 rn <br />T; <br /> <br /> <br />EPA Form 3320-1 (Rev 3199) Pre pious editions may be used _ Tit is 1S,• a 4-Dart f(jrm. PAGE OF