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PERMITTEE NAMEMDDRESS (Ymh-& Fw*"Na.?Lxaran VOff-r) <br />NAME <br />ADDRESS RK <br />RSET CU E3 <br />FACILITY ?'.'NN CRK MINTS <br />LOCATION RESET co 0 <br />,._.q T rt-1fir'l t k, FkF(I V. P. <br />NATIONAL POLLUTANT DISCHARGE EUMINAT10H SYSTEM NPOES) <br />DISCHARGE MONITORING REPORT (D RI <br />PERMIT NUMBER DISCHARGE NUMBER <br />34 <br />MONITORING PERIOD <br />34 YEAR MO DAY YEAA O DAY <br />FROM TO <br />M? NOR <br />c SUBR M <br />Form Approved. 1, <br />OMB No 2040-0004, <br />1 <br />LjBl-;ARI) CRH <br />NOTE: Read Imtnictione before comploting thla form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. <br /> <br /> <br />EX FREOUENCY <br /> <br />OF <br />SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ?: -:. }; ;I•#? <br /> REQUIREMENT ? t:? x I i ? I _I <br />_ SAMPLE <br /> MEASUREMENT <br /> PERMIT - :. - - <br />F REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT .,. o , . r.r -_• . <br /> REQUIREMENT AV <br />T-Px- SAMPLE <br />T• E j MEASUREMENT <br />G C PERMIT :. ?. <br />'DENT GROSS REQUIREMENT )Lir1 r;'J( i <br />?'•._ SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />Jf- -7 <br />-5t , <br /> REQUIREMENT ~{- r I'IAX <br />111P-l . I <br />Uyl <br /> <br />SAMPLE <br />_l3 P!_ `?N! MEASUREMENT <br /> PERMIT I : M, <br /> REQUIREMENT _10DA A' <br />r. "F <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT r i ..• Y y <br />F <br /> <br />"" <br />NAME/TITIE PRINCIPAL EXECUTIVE OFFICER ' M~' y " e pen'" to. that th <br /> <br />prepared under my direction w xtpe h doormen/ and W sllwhmmts -ere <br /> <br />rNdon In ar<vrd.nn +Ilh . system deslZrrd <br />TELEPHONE <br />DATE <br /> to assure that q"0111ed ptetw,-l Properly i.lhee .nd e..luae the Inrnrm.tlo. <br />Based on my Inquiry of the person w persons who manare the system <br />submitted <br /> <br />- * - . <br />- <br />or those perttorts directly mporsdblr fw g.therlot the Infofm.rloa, the Inrorm.tlon / _ - <br /> <br />! ? <br />1 ' <br />' _ <br /> <br />' <br />/ <br /> <br />% <br />' subm111ed K to the best of my bmwledge and bt*rf. tme. a-srole. and complete. <br />dtl <br />t <br />I <br />h <br />d <br />l <br />f <br />ti <br />I 4I0NATURE Of PRINCWAL EXECUTIVE ' <br />' • <br />- - <br /> I lm ...re that t <br />ere am <br />p <br />na <br />pen. <br />r <br />" <br />or rubmlt <br />nj falsr <br />nforr don. AAEA <br />TYPED OR PRINTED Including the poadbuny or nne and Imprttemment ror It-Int .ld.Ur OFFICER OR AUTHORIZEO AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OI• AMT VIULX I IVN5 fHararence M arracnmenrs nora) <br />pi_ FA!?t_E S(7L ?LAS f -MT A.F'PI, I E !'I FQR ^=1 f7, ?41-HR PRi=Cs T P ct?rc}W-r. <br />EPA Form 3320-1 (Rev 3'99) Previous editions may be used This is a 4-pan forth. PAGE OF