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PERMITTEE NAMFJADDRESS (7wei4 F-iktyAr - (Lerartow ((D(OFw) NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM /NPOES) <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS <br />J. BOX s" PERMIT NUMBER DISCHARGE NLWSER <br />'--'SET <br />FACILITY ORN CRK MONITORING PERIOD <br />LOCATION RSET co YEAR MO DA YEA MO D Y <br />- <br />'.>=S T. COOPER EXEC V. F- FROM TO <br />Form Approved., <br />_ OMB No. 2040-0064 <br />F - F I f-;r <br />SURF RUN-OFF ii-) N F K iif?Iv 150Pd R <br />NOTE: Read k»trucdone before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREOVENCY SAMPLE <br /> 1>< OF <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT y IL; h: I 1 ' <br /> REQUIREMENT h; I N I :"^t ,t': MAXIMUM MCt .,•iT' <br /> <br />L_ I ML. SAMPLE <br />i dDE ?- MEASUREMENT <br /> <br /> PERMIT , _ it <br /> REQUIREMENT -'•(''UA A'JU GAILY MX ':I-:i•dTH <br /> SAMPLE - <br /> MEASUREMENT <br /> <br /> PERMIT r, ,. <br /> REQUIREMENT 'UA AV,:' DAILY MX MONTH <br />. SAMPLE <br />4S FE: MEASUREMENT <br /> <br />0 PERMIT : c .. <br />?-JENT GRC,: REQUIREMENT <br />310 D A r. <br />DAILY MX: <br />:i.i'IFI <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT t <br /> REQUIREMENT H:- T MAX C E: i <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT - <br />;FNT GROSS v i- REQUIREMENT " iILY MX <br />- - SAMPLE <br /> MEASUREMENT <br /> <br />PERMIT <br />REQUIREMENT ,NST MAX MONTH <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER ' mr'"y ° e' Pe"' ty o Iaw that this document and all'llach-ts were TELEPHONE <br />Prepared under me dimcilon or mper+ffon In accordance with a system deWgned DATE <br /> <br />. •.? to assure Iltat qualified Persanael Properly gather and evaluate the Inrornsatlon <br />Submitted. Based an my Inquiry of the person or person who maetaga the system. <br />- f <br /> or thous persom directl <br />i <br />res <br />omilble for <br />ath <br />the I <br />f <br />ti <br />th <br /> <br />- y <br />p <br />g <br />er <br />ng <br />orma <br />n <br />on, <br />e Information <br />• I _ <br />- submtlted W. to the best or my knowledge and beset, tree, ncc mte, and complete. <br />.' I am aware tM1 there are dpdfkant penalties for Submilting False lnformatlon SIGNATURE OF PRINCWAL EXECUTIVE <br />TYPED OR PRINTED . <br />InAuding the po'rblNty orfine and Imprisonment For knowing ooletlom OFFICER OR AUTHORIZED AGENT CODE NUMEIER YEAR MO DAY <br />COMMENT5 ANU tAr'LAnAIIUn Ur ArtT YIULA11VnJ !Preference avf 8tT8CMnenrt neral <br />L.FAT.n.E 4CJLIDS LMT APPLI?=T; FOR IOYR, :?4HR PRFrTr F'.'L^''T <br />I F <br />ThtS t9.H 4-?ft IgrTn. PAGE OF <br />EPA Form 3320-1 (Rev. 3/99) Previous editions maybe used v