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PERMITTEE NAME/ADDRESS dw1wle F(wifin'.Yame. Lrnnrron if 0i error) NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS f'IH'•: I l l ?+ <br />F' . C. EC X PERMIT NUMBER DISCHARGE NUMBER <br />FACILITY 7RENC: MONITORING PERIOD LOCATION, R MI YEAR MO DAY YEAR MO DAY <br />DEN FROM TO <br />;1F?:•?F <br />Form Approved. <br />OMB No. 2040-0004 <br />MINOR <br />(SUBR is ) X . <br />F - FINAL <br />POND A%TR <br />IB TO CANADIAN RIVER <br />NOTE: Read Instructions before completing this form. <br />! C, M(.:.,1% <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. I FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE ! <br /> MEASUREMENT <br />I:a?:,,'? (: 7 PERMIT <br /> REQUIREMENT fir, .: = 'JM MONT. <br />01-1i,t; = rr 7,1',BLL SAMPLE <br /> MEASUREMENT <br /> PERMIT r> #### #? ###s?#i R F P 0 R T I C). 5 WIC'E% GR- <br />LUEIV I .',ROSS VAL',i_ REQUIREMENT 30DA A`JG DA 11- <br /> SAMPLE ; .. s?t<:•? <br /> MEASUREMENT <br />= PERMIT # `i h i3 <br /> REQUIREMENT <br />i i ?U 1 T SAMPLE <br />I <br />7 }1F:ii :. 71 :N T tit ;`+iJi MEASUREMENT <br /> PERMIT REPORT REF ORT <br />F* FL U E N T ;R I='S iALi t: REQUIREMENT 30DA AVG i!A.I i_ Y <br /> SAMPLE <br />i 15U MEASUREMENT <br />E PERMIT :ix?it =i ##i?ii rii iEiE#iitF# #si "ie## LICE/ A <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAMEJTITLE PRINCIPAL EXECUTIVE OFFICER I certify under penalty or law that this document and all.atachine s were <br />d <br />-i TELEPHONE DATE <br /> prepared under my direction or super%-on to accordance with a system <br />es <br />Kned ?- <br />- <br />l. i c hard V:1 • ,' 11n sOI1 ,. essure that quahticd personnel properly gdthcr and evaluate the utformnnrm z. <br />` <br /> utsnumd Based on my inquiry of the person or persons who manage the syatem. /• [ , , ?' ! <br />,/,.t tea - <br />Vice Yre `, i d F i,t or thou persons direr ly rv. ponsible lit gathering the infomtation. the information <br /> submitted is <br />I,, the hest of m} kit-ledge and Niter <br />true <br />accurate <br />and complete 3 4338 <br />? `2 r q 1r' 06 <br /> . <br />, <br />. <br />, <br />t th <br />t <br />l <br />l <br />l! <br />G <br />h <br />l <br />l <br />th <br />f <br />uti <br />f <br />: <br />, SIGNATURE OF PRINCIPAL EXECUTIVE - <br /> <br />TYPED OR PRINTED . an <br />r <br />e <br />m <br />i- <br />ar su <br />se m <br />orr ?' <br />n <br />am aware <br />a <br />ere are s!gm <br />m <br />ng <br />a <br />. <br />nu <br />l <br />di <br />sih <br />cf fi <br />s <br />d n <br />u Io <br />A <br />- <br />u <br />th <br />lit <br />lan" OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br /> rpn, <br />u <br />:u <br />ma <br />o <br />i vw <br />inc <br />ng <br />e pos <br />t <br />y <br />n <br />r <br />n <br />u` CODE <br />GVMMENTS ANU "PL.ANAI IUN OF ANY VIULAI IUNb (Kererence an arracnments nere) <br />':r-CIP EVENT SUBJECT TO BURDEN OF PROOF REQUIREMENTS IN <br />TO THE DIVISION WITHIN 48 HOURS. <br />EPA Form 3320.1 (Rev. 3/99) Previous editions may be used. 0030 i ?t ....- 4-?1HrI; lt?rtn.