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IaERMITTEE NAME)ADDRESS (l.t+r4 F-OlyN...WLacr,o. ((D(f-wo) NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM frNPOESI <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS <br />b UX PERMIT NUMBER DISCHARGE NUMBER <br />•iERSET <br />FACILITY !BORN CRK & LL V. 1`11 E MONITORING PERIOD <br />LOCATION C , ! :l YEAR MO DAY YEAR MO -D Ay <br />!ER SET <br />.iMES T. COOPER, EXEC V. P. FROM TO ' <br />Form Approved. <br />OMB No. 2040-0004 <br />MINOP. e <br />(SUDR <br />F - FINAL GUNIt <br />DISCHARGE TO ELK CREEK <br />NOTE: Read Instructions before completing this fwm. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. EOUENCY SAMPLE <br /> <br /> <br />E OF <br />r <br />YPE <br /> X A <br />ANLYSIS T <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT ` <br /> REQUIREMENT MINIMUM :aX I MUM MONTH <br /> SAMPLE <br /> MEASUREMENT <br /> <br />_ PERMIT c . 7 _W 1t <br />i' `: L• <br />`UENT -i<O -L3 ALt J. REQUIREMENT 30EI? AV' 011 D i-v MON I- <br />- SAMPLE <br />;S FE ' MEASUREMENT <br /> <br /> PERMIT =: i.. <br />! :'+ REQUIREMENT 30DA A VG DAILY MX MONTH <br /> SAMPLE <br /> MEASUREMENT <br /> <br />= PERMIT <br />'. E'• REQUIREMENT INST MAX <br /> SAMPLE y <br /> MEASUREMENT <br />50 1 0 PERMIT . r OI , : }. s .,:. 4 i _ I 77FAT <br />LUENT GRI!: REQUIREMENT -!`A AV,-, iIL'r' illX tVTk- <br />kiPE717 SAMPLE <br />;UAL MEASUREMENT <br /> <br />bb 1 0 PERMIT - x _.. - <br />!! _ ^•; ? (-: ,_ _ REQUIREMENT NST MAX } <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I nrtny a r Pena b o (Is. that lhb dmvmenl and all attachments were TELEPHONE DATE <br />prepared under my direction or suprrrhlon In accordance with a syslernt designed <br />T to swum that quonfl d personnel properly gather and tsNuale the Inforwullon <br />r'..:• <br />it <br />I <br />i <br />f th <br />• <br />b <br />d <br />B <br />d <br />- - <br />on my <br />ry o <br />- <br />su <br />m <br />te <br />. <br />ase <br />nqu <br />e person or Presents who manage the syslrm, <br />dir <br />tl <br />re <br />n0bl <br />fo <br />th <br />ri <br />I <br />th <br />th <br />f <br />ti <br />th <br />- or <br />ose persms <br />ec <br />y <br />spo <br />r ga <br />e <br />ng <br />n <br />e <br />e <br />orma <br />on, <br />e Information <br />knowl <br />b <br />th <br />b <br />ll <br />f m <br />d <br />d b <br />tr <br />t <br />- ! <br />itt <br />d 6 <br />t <br />li <br />f <br />d <br />-? <br />m <br />e <br />. <br />o <br />e <br />e <br />o <br />e <br />e <br />ge ann <br />e <br />e <br />ot, accura <br />e. an <br />su <br />, <br />complete. <br />. - - <br />I ..aware that them an si <br />nincanl <br />-111cs tar, rubmiuin <br />W. Infnr.natlo. <br />SiONA TUBE OF PRINCWAL EXECUTIVE l <br /> g <br />g <br />P <br />, <br />TYPED PRINTED Including the pc®Iblilty of clew and imprisonment foc k-Ing ricosdam OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS /Reference aN attachments here) <br />PERIOD REPORTI <br />EPA Form 3320-1 (Rev. 3)99) Previous editions may be used. <br />GREASE - SEE I. B. I. D. <br />0053, , C hi4l jsg8 4-Pari form.