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PERM"nE NAWJADDRESS (/arbii rWyN...NL«.rsaw (/D(dr,..,) NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (/NPOES) <br />NAME DISCHARGE MONITORING REPORT (OMR) <br />ADDRESS <br />-. BOX 53'< PERMIT NUMBER DISCHAAGENUMSEiv <br />:ERSET ? <br />BORN CRK E_ir. CRK. HIN S MONITORING PERIOD <br />FACILITY <br />LD?TIDN !ERSET Ci_. YEAR MO. D YEAR O D &Y <br />FROM TO <br />ME5 T. COOPER, EXEC V. <br />MINOR <br />(SUBR MH) <br />F - FINAL <br />SURF R(JNOF <br />Form Approved <br />OMB No. 2040-0000 <br />; :N <br />JN <br />NOTE: Reed Irmtructiom before eompiet" this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. <br /> <br /> <br />EX FREOUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALrSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT MINIMUM MAXIMUM MONT <br />- SAMPLE <br />C! MEASUREMENT <br />x0530 PERMIT a ra 7777:: <br />i FF"LUEN • REQUIREMENT 30DA AVG DAILY MX t-`ONTH <br />- ' SAMPLE <br /> MEASUREMENT <br />,I) PERMIT ?W w- - r; <br />r F 1_lJ .!'•I? REQUIREMENT 30DA AVG DAILY Mx t ._ ;. 1'ONT1- <br /> SAMPLE <br /> MEASUREMENT <br />`1045 ! PERMIT 'L <br />UENT REQUIREMENT 30 DA %•'. PAIL Y MX P-ONT <br />v SAMPLE <br /> MEASUREMENT <br />r32 1 O _ PERMIT ... - # fi c <br />EFFLUENT GRU`,7_,, REQUIREMENT INST MAX ENT <br />;k- h t SAMPLE <br />J J REAT1-`)_i.IT P: MEASUREMENT <br />r:: PERMIT <br />F L.. `?Ai- - REQUIREMENT _ 0DA AVG DAILY MX `iT <br /> SAMPLE <br /> MEASUREMENT <br />- <br />, PERMIT <br />"! . REQUIREMENT SR TR AVG DAILY MX <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER 1 cantor u r pane , o bw Ihat t <br /> <br />prepared coder my direction or sup s document and an ¦ttachmenb wen <br /> <br />errtslon In aceordar.c< with • system designed <br />TELEPHONE <br />DATE <br /> <br />r <br />, . T i` ^ Z? " <br />!t ? to asswn that owanned per,onnel property gather and evaluate the Inror. (Ion <br />w,bmltud <br />eased on mr Inquiry or the person or persons who ma Cage the system _ <br />- <br />r <br />_ <br />; , <br />or chow, directly responsible for gathering the Informauoe the Information I <br /> submitted N, b the best of my knowledge and belief, Iraq accurate. and complete. <br />ifi <br />a <br />t <br />i <br />l <br />b <br />l <br />i <br />516NATURE OF PRINCIPAL EXECUTT/E <br /> es for aw <br />1 am swan that then an s <br />gn <br />c <br />n <br />pena <br />m <br />aing labor Inrorrnatkm. <br />t <br />I <br />h <br />dblil <br />f fine and Im <br />i <br />f <br />k <br />i <br />l <br />h <br />l <br />d <br />OFFICER OR AUTHORIZED AGENT A A <br />NUMEIER <br />YEAR <br />MO <br />=DAY <br />TYPED OR PRINTED nc <br />y o <br />pr <br />sonment <br />now <br />ng r <br />miing t <br />e Po <br />or <br />o <br />o <br />oen CODE <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS /Ra/aranca aN attachment: hers) <br />t .FAD!--E `30LIDS LMT APPLIES FOR r=10YR, 24HR PRECTP EVENT; <br />c - W0'-:; - - - <br />EPA Form 3320-1 (Rev 399) Previous editions may be used. T J e? PAGE OF