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PERMITTEE NAME/ADDRESSpwcbiirWryNoe?Lxati w(fD(&6 t) <br />NAME <br />ADDRESS <br />J. BOX 53S <br />SOMERSET C! <br />FACILITY ,""BORN CRK R ELK CRK Mil <br />LOCATION 1ERSET CI <br />-,MES T. COOPER, EXEC V. <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDESI <br />DISCHARGE MONITORING REPORT ID RI <br />PERMIT NUMBER DISCHARGE NLN.IDER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />a FROM TO <br />0 <br />Form Approved. <br />OMB No 2040-0004 <br />MINOR <br />(SUBR <br />F - FIi <br />SED1flEi-?i r.?i•u +_! r!-:LJ L'^ 'J if i<' <br />NOTE: Reed katructlorw before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, <br /> <br />EX FfIEOUENCr <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ,F#)t##iF #a t? ': e4. r3 ## ?' O <br /> REQUIREMENT M I N I MUI" MAX I Ml?!"} MONTH <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ##?t # # c 3t ##3t )t# 35 <br />10 <br />1 <br /> <br />i <br /> <br />'? `. ' <br /> REQUIREMENT -'-,()DA DA IL_•` fl;X <br /> SAMPLE <br /> MEASUREMENT <br />0 PERMIT ####<' i " + - ####3E# REPORT REPORT t .1 N' C <br /> REQUIREMENT 30DA Al ';_ DAILY MX l1CiPa i ; <br />,L. SAMPLE <br />-- MEASUREMENT <br /> PERMIT ' tf### ## >t# tt# ': ## # ## : l-QQ OOU r'd+? R ?;i <br /> REQUIREMENT ?ODA AV G DAIL'1' MX MONTH <br />_ SAMPLE <br /> MEASUREMENT <br />Z2 1 C PERMIT ###### 2r###i(iF - z xbe `r sril z# i. ti <br />UEN 1 REQUIREMENT I NS T MAX' <br />'. ! SAMPLE <br />i TR; F; MEASUREMENT <br />=.C1 PERMIT REP OR I REPORT <br />F I_'•. I'•i .i ;:_ :? `',' '.. REQUIREMENT Q(jq =1 ILY MX MONTH <br />A , c. EA .9 SAMPLE <br /> MEASUREMENT <br />PERMIT THE ##it st ; .. r <br />REQUIREMENT rl,ccT MAX <br />?9Ct': <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER i C rt y ° r Pen. ty o le. that u,a document and .M ¦llachmenu .err TELEPHONE DATE <br />Prepared under my direction or fuperrWon In mcm ancr with a system designed <br />to .sure that quaMned personnel Properly gather and eralume the Information <br />1 .• _ sobrrrlted <br />¦aaed on m <br />Inquiry at the Peron or <br />erson who mana <br />e the s <br />tem <br />, <br />. <br />y <br />P <br />g <br />p <br />. / <br />• or those persons dlr tlr rrspoiedbte ror gathering the Information. the Infornrtbn <br />•- submined h, to the best of my knowledge and beMef, true. ac-rare. and complete. <br />t •' I <br />th <br />t th <br />i <br />nifi <br />]SIGNATURE OF PRIM CMA EXECUTIVE - <br />t <br />l <br />f <br />b <br /> am mare <br />ere are s <br />g <br />can <br />Pena <br />a <br />ties <br />or su <br />mitting War Infor nstlon• ARE <br />TYPED OR PRINTED Including the Possibility of tine and Imprisonment for knowing Aolauorm OFFICER OR AUTHORIZED AGENT CODE NUMEIER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS fRefersnce 0# attachments here/ <br />;::,: l _MT FPLIED FOR 1CYR' _- +'rii' <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. _ J T?1LS JS S 4 part rosin. PAGE OF