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PERMITTEE NAME)AODRESS prey FaAbryWaw?L-mien t(DW-i) <br />NAME <br />ADDRESS <br />BOX <br />C, C3 <br />FACILITY !; OR N CE ' MINI <br />LOCATION :_'RSET 1 U <br />1ES T. COOPER, } '1. f <br />NATIONAL POLLUTANT OISCHMOE ELIMINATION SYtlTE1N NPDESI <br />DISCHARGE MONITORING REPORT (D R) <br />PERMIT NUMBER DISCHARGE NUMBER <br />,34 MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved. <br />OMB No. 20404004 <br />MINOR <br />(SUDR MH) <br />F - FINAL <br />RUNOFF' TO N FORK GUNNIS01 <br />NOTE: Reed instructions bsfors complet" this form. <br />NIS <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, QUENCY <br />OF <br />r SAMPLE <br /> <br />E <br /> EX ANALYSIS TYP <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT #i. ## ##? ?< b. ; #if###ir 9. Q tjCE/ IPa .( . <br /> REQUIREMENT hl I c " " MAX I MUM PIONT <br />DS, f ; SAMPLE <br /> MEASUREMENT <br /> PERMIT # r--.. Fi # i fic# 4 sr ; :: ., <br /> REQUIREMENT 7't., <br />3-L ! SAMPLE - i <br /> MEASUREMENT <br /> PERMIT # # # ### ## #is REPORT R PORT NCF/ GRAD <br />t )EN i REQUIREMENT z OODA A-1? DAILY MX MONTH <br />( i. SAMPLE _ <br /> MEASUREMENT <br /> PERMIT r t## ###at## ittl•#it#i? OOI> X040 NCE/ GRAB <br /> REQUIREMENT 30DA AW:' DAILY MX MON T <br /> SAMPLE - .. „ <br /> MEASUREMENT <br />2 v_ t) PERMIT #### #IE#### ##### IE >; ### 1 0 tai! - . <br /> REQUIREMENT s?, ; T I' i? f !' > F <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT REF" T REPORT 4*-c •e +> "NCF <br /> REQUIREMENT ' <br />i <br />' 4 <br />'ROSS 'O <br />DF A <br />v ! ; <br />i I LY MY MUIV ' I <br />tGF! SAMPLE rq ,. <br />>. MEASUREMENT <br /> PERMIT REPORT 'i <br />L <br />A <br /> REQUIREMENT NSTT MAx <br />NAME/TiTLE PRINCIPAL EXECUTIVE OFFICER t " fl,ty ° er pen." 418- that We docromenl and all attachntrnU were <br />prepared under my dicn lion or spec.{/on in accordance with a symern designed TELEPHONE DATE <br />r <br />• to aaaars that quaMnre personnel properly gather and evaluate the Information <br />mlbrAtted. Sawed on - Inquiry of the person or persons who manart the system <br />`. <br /> , <br />th <br />i <br />l <br /> or <br />ose Persons direct <br />y respons <br />ble nor gathering the InFormatlon• the lnrormation <br />-?- submitted Is, to the bent of my 1,no Stdre and hehef. titre, a -W and mroplete. <br />I .m a..r tha there - rt <br />nlncant t-slr r..r mh,.,nrln <br />fdv r -trh- I <br />SIGNATURE OF PRINCIPA EXECUTIVE <br />• <br />TYPED OR PRINTED r <br />f <br />n +udinn the poscl r n K OR AuTr+oF. zEO AGENT Co?E NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reforenc• a# attachmonta hers) <br />;.FABLE SOLIDS LMT APPLIF"7t FOR , 1r1YR, =_'4H9 P JT- Tr r. <br /><. ? R, :=UFI\IT-SFE I A. 1, f 5 <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. TIus'IS"a 4-part fi PAGE OF