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PERMITTEE NAME/ADDRESS (7-h k FwOfYNr.WLacnron I/D(#Wvw) NATIONAL POLLUTANT OISCHAROE ELIMINATION SYSTEM (NPDES) <br />NAME DISCHARGE MONITORING REPORT IDMRI <br />ADDRESS <br />J• BOX PERMIT NUMBER DISCHAROENUMISM <br />;'•1 ER SET <br />FACILITY -4D0RN C R r. ('1 - (': f MONITORING PERIOD <br />i 1ERSET YEAR MO D Y YEAR MO DAY <br />LOCATION FROM TO <br />"'MES T. COOPER, EXEC V <br />Form Approved.. <br />OMB No. 2040-DO04 <br />( 5UBF? ('i" ; ? <br />F - FINAL DISCHARGE TO ELK CF-%F--:-V, <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FTIEOUENCY SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE - <br /> MEASUREMENT <br /> PERMIT ... x ... <br /> REQUIREMENT M I N I MU['i I'iA X I MUM _ MONTH <br /> SAMPLE <br /> MEASUREMENT <br /> <br />v L: - PERMIT <br />LUENT 1--TRUSS J1 REQUIREMENT :30DA A`.i 1'ih i% AV <br />c10t'4Tt? <br />0 At: SAMPLE <br />.3S FF_ : MEASUREMENT <br /> <br /> PERMIT z r 'r <br />JEf'4i REQUIREMENT 30DA ltVG DRILY MX MONTt <br />x. SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT + INS i HA <br />t SAMPLE <br />i :?±-<11 hl;_ MEASUREMENT <br /> <br />=Q 1 0 PERMIT <br />'.I' UN I <br />- <br /> <br />r <br /> <br />a .:-. <br /> <br />t <br /> REQUIREMENT JGA AVG DAILY Nli{ `, - 4TH <br />77 7 SAMPLE <br /> MEASUREMENT <br /> <br />C) PERMIT F r -x .... ?' <br />i1t.i •; r REQUIREMENT 4ST MAk' <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />NAMElTfTLE PRINCIPAL EXECUTIVE OFFICER I Kr"y " r penalty *(I.- that this document and all machrrtenu wen TELEPHONE DATE <br />prepared under my directlon or mper.Mon In atcordann with • system designed <br />to inure that qualified personnel properly iHher and evaluate the Information <br />submitted. Bred on my Inquiry of the person or persons who manatie the system, <br />or those persons dlrerty misomlble for gathering the Inferrrutum the information <br />4- submitted Is <br />to the best of my knowledte and belief <br />true <br />arrurate <br />and com <br />lel6 1- <br />. <br />, <br />, <br />. <br />p <br />. <br />t .m ...n that then ere drMli-t <br />enattles rur subs lIlr <br />f.ts. Wormatbn <br />SIGNATURE Of PRINCNAt EXEcvmm <br /> p <br />e <br />. <br />TYPED OR PRINTED nctuelnf the possibility ar nne .ate 1m;,H or,meni ror kr ,-Int .kA.U- OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANA I IUN Ur An T V IVLPk I wrro flforsrsncs an, terrncnm,rnra nsrsf <br />PERIOD REPORTEI <br />3REASE - SEE I. B. 1. E <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used :; ` _; ;' jyetr?r<-Q3IYQTi11.