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PERMITTI;E N,4M.?IADDRE'+5(7..rb6FaiUyXwrlee•?rt.nl/DIQf.wvl <br />NAME <br />ADDREss _ ELK. CRK :'aLS <br />O. U0r: .5 L3 a <br />,..1FRESET CO E3 <br />FACILITY ,,fJRN CR!? F. ELI; !"TNES <br />LOCATK>N -RSET U 8 <br />LIES T. COOPER, EXE-• F. <br />NATIONAL POLLUTANT OISCHMGE ELIMINATION SYSTEM /NPDES/ <br />DISCHARGE MONITORING REPORT (D R) <br />PERMIT NUMBER olsC?rAnoE NuMeEn <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO - - <br />Forrn Approved <br />xre r,1 ?ca?-oo?.. <br />MINOR <br />(SUBR q <br />;-iURFACL. <br />NOTE: Read instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREOUENCY SAMPLE <br /> <br />EX 0 <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT -' ...- .r <br />VALUE REQUIREMENT i ? I y I i~ ; :;=. <br />•- t T,•It )F? _ .•' N-ONTH <br />77777- <br />SAMPLE <br />_ <br />??T <br />- <br />!ENDED MEASUREMENT <br /> PERMIT <br />-'._ir-NJ =RID L REQUIREMENT _?inn AVM: I•i'. 7 ) (`, y' I`ilJfd I <br />- •- _ - a' - c SAMPLc' r s <br />r, T <br /> <br />- <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT - - ' <br />- ., SAMPLE <br /> MEASUREMENT <br />7 I C: CI <br />PERMIT _ <br />` i7-NT GROSS VA: t REQUIREMENT 3C)GA AV;, <br />CIA I L'>r t?! x. <br />M`I,ITu <br />.•, . SAMPLE - <br /> MEASUREMENT <br /> <br />1 G O PERMIT <br />!.UENT GROSS VALUE REQUIREMENT - ?'f?= " i GErv i <br /> SAMPLE <br />'. (i EAI MiP+ F1Lr'?N! MEASUREMENT <br />;J 1 n U PERMIT -- , <br />U NT GROSS VA!-_'._" REQUIREMENT 'ODA AVG A'iL'Y rIG <br /> SAMPLE , .- . ... _ <br />;;AL. MEASUREMENT <br /> <br />' • PERMIT <br /> REQUIREMENT <br />- ; r x <br /> <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER thtl thh d--nl nd an .tlavhn-L,. e <br />i nnry under prna y o • TELEPHONE DATE <br /> prepared undrr my dines tH•n er sups relslon In aeeordanre with . syrlem desf=ned <br /> to - that qu.NM-d ptnnnnel properly [alien and e.alualr the Innor 16" <br />submitted. eaatd on my irpuln -(the prrwn or pln who marr.tt th. fystrm /- -. <br /> or those ptrsete d1wils respoenlble for talhrAnE the Informatlnw. the Infotmation <br /> <br />/ to the best of my km-kdgt and be W <br />subrollttd Is <br />1rnr..reunlr. and mropktt. <br />` _- <br /> . <br />, <br />l <br />nlft <br />m <br />ld <br />f <br />ltti <br />f <br />I <br />f <br />h <br />b <br />h SIGNATURE OF PRINCWAL EXECUTIVE <br /> g <br />en art s <br />u <br />pen. <br />ea <br />. <br />1 am assn that t <br />or - <br />m <br />ng <br />t <br />n <br />ormation. A AEA <br />TYPED OR vaWTED lnduding tha poodblllty of One and Imprf o-nt for k-Int .idatl r OFFICER OR AUTHORIZED AGENT NUMEIER <br />CODE YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reforencs a// affachmanls hers! <br />-"Fl-FAIIi_.E F'DLID9 !_MT APP!-IE'D FI)R "-20, 24!IR PRF!"IP El?rr4T: <br />This 15 a 4- an.Porm. <br />p <br />EPA Form 3320.1 (Rev 3/99) Pre (ious editions may be used PAGE OF