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PERMrME NAME/ADDRESS (IwoWr FwrWryN,n?Lor.rfew ((D(oi,.w) <br />NATIONAL POLLUTANT dSCHMOf ELIMINATION SYSTEM (NPDES) <br />NAME DISCHARGE MONITORING REPORT tDMR) <br />ADDRESS <br />SOX ` PERMIT NUMBER 71C7-mw NUMSER <br />=RSET - <br />FACILITY ':ORN CRK y: tt MONITORING PERIOD <br />L! •. ;?;i k, i1 I I': YEAR MO DAY YEAR MO DAY <br />LOCATION :_RSET CC FROM TO <br />IES T. COOPER, EXEC V.: <br />M I NOR <br />F - FINAL <br />SURF RUNOFF TO N F <br />NOTE: Reed Instruction before completing this form. <br />dNIS <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ, FREQUENCY SAMPLE <br /> of <br /> EX ANALrSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br />## <br />jr . ,. ;• <br />6. <br />t#### <br />4. 0 <br /> <br />?. i <br />I'd <br /> REQUIREMENT I'7 I N 1 r itJt'f r lA X i M(. i i t . ti <br />i. :... SAMPLE ;• . <br /> MEASUREMENT <br /> PERMIT 3t##:t#it a###?# #tt#### ?,'? ?i.:; E/ A <br /> REQUIREMENT C:' l U 1 L , "-J14 <br /> SAMPLE - <br /> MEASUREMENT <br /> <br />45 1 v PERMIT x # It### ###### ?i ##### [ -Rfj ; T REPO-Pr- i L Fl <br /> <br />_UENT G:kr.1' <br />REQUIREMENT <br />a{3Yr'j AV<- <br />DAILY M:i. <br />P90''•' . <br />hN r TOTAL SAMPLE <br />p c F r' MEASUREMENT <br /> PERMIT ###### ? c::t## itiP#### 3500 7000 <br /> REQUIREMENT ; 3ODA Al•/',_ DA I L ;' N X {`1 C, <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ##iP ### #IE#9F## ####4t# ## l'•:l <br /> REQUIREMENT „ INST MAX <br /> SAMPLE <br />i i t(i i i (Lid i t MEASUREMENT <br /> PERMIT REPOR-f REPORT t:: _ . ,... - ?r:r fx## _ , .cj• <br /> REQUIREMENT 30DA r" ;{ILY Mid <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> <br />PERMIT *****-N <br />REPORT <br />REQUIREMENT %IS T MAY t `fJ <br />NAME/TiTLE PRINCIPAL EXECUTIVE OFFICER t cerrry ° nder Penally " I- that Nis document .M nil ¦tl.chmenb were <br />TELEPHONE <br />d <br />d <br />DATE <br />prtp.re <br />un <br />er my direttbn or wPer.Iston in .fcord.nce with . system ddEned <br />- . I <br />^-^'1 to New" that qua feed personnel properly gather and er.hrate the Infortmalbn _ <br /> mbmitted. Seed on my l,pulry of tM Peron or pe? who manage the enttrn, <br /> or Ihose pe aore directly re,porrdbk for gathering the Inromnelbn, the Inform.tion <br />_ t - submitted K to the best of rm tnowkdre ¦nd belle!. Ime, . rite, and eomtpkk. <br />/ <br /> I .m -m that there ere s1(d8cint penalties for wbmttting Wer Information, J SIGNATURE OF PRINCMAL EXECUTIVE <br /> <br />TYPED OR PRINTED <br />Inrtuding the pmetbilltr of fine end Imprisonment for knowing violations. <br />OFFICER OR AUTHORIZED AGENT AREA <br />CODE NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference ell ethchmenta here) <br />T. TiS I -MT APP1 Fr} OYR , <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. T 15.3.4-Part form. PAGE OF <br />:. <br />Form Approved. <br />OMB No. 204040004 <br />•