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PERMITTEE NAME/ADDRESSp-&-AJr &,YliawWL«rfetl(D(fnwn) <br />NAME <br />ADDRESS <br />?. uOx 5?5 <br />:9ERSET Cl <br />FACILITY NBORN CRK. .'.- ELK CRK MIl <br />LOCATION MERSET CI <br />AMES T. COOPER, EXEC V. <br />NATIONAL POLLUTANT DISCHARGE EUMINAnoN SYSTEM //NPDESI <br />DISCHARGE MONITORING REPORT IDA4R) <br />PERMIT NUMBER DISCHAAOE NUMEER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />7 FROM TO <br />P <br />Form Approved <br />OMB No 2040-00154 <br />M I NOF <br />(SUBR MH ) <br />F - FINAL GUM <br />SURFACE RUNOFF TO ELK CREEK <br />NOTE: Read Irntrucdone before cornpleting thle form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ, FREQUENCY SAMPLE <br /> OF <br /> EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />ti l MEASUREMENT <br /> PERMIT # It# :, REPORT x?l !E It#?? #?t ate ## 'CE.' <br />' I ?Ur? <br />?_lJr.:'l F? REQUIREMENT i NST MAX <br />T <br />f <br />MON <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />NAMEf"TLE PRINCIPAL EXECUTTVE OFFICER ' C"t", ° r p°na iy ° l.w that lhh document and all tl ch.ta were TELEPHONE DATE <br />prepared under my dimciton or wper.t>lon in wmrdanre with a system dd?ned <br />- v-?, to now" that qualified llwonoei Properll Gather and .eahaale be Infnrmatbe <br />I <br />submitted. seed on my <br />nquiry of the person - prnar who nrnaFe the system, <br />th <br />r <br />dl <br />tt <br />re <br />dbk F <br />th <br />I <br />th <br />A <br />r <br />u <br />t <br />t..; ' <br />'. "' • '.• - <br />ose Prsa <br />rec <br />y <br />spae <br />or Fa <br />e <br />nF <br />n <br />e <br />e <br />orma <br />ow, <br />he InrormaU°n <br />- <br />-4- of <br />wbmltted K to the best of m <br />It to <br />I and belle! <br />nle <br />t <br />nd <br />l <br />Irv* <br />t <br />y <br />. a <br />cv <br />, a <br />comp <br />e <br />e. <br />. <br />II <br />- <br />• - 1 am aware that there ore 909*11caat p.naltle for wtbmlttln{ rat: Inrorm.t <br />lon <br />SIGNATURE OF MINCNAL EXECUTIVE -- <br />TYPED OR PRINTED , <br />Indrelnt the ponibitlly of Ian. and Imprlaonmrnt for knowing .Ioisuorn OFFICER OR AUTHORIZED AGENT AKA NUMBER CODE YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS /Re/aronc• all attachments heral <br />LEAPLc SOLIDS LMT APP! IrP FOP. "=1OYR, 24 HR PP.F'.'7 <br />ENT-SEE 1. A. iL i . A. F' i <br />C: t t r. r. il^JAI F ;y AU(7; I -ci H T I i iN l '{, AVQ I) R I NC: <br />Tlti& ) 4- rep. PAGE OF <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. 6+ ?-f