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PERMITTEE NAMEJADDRESSp-&&F--dryIVo*dLerwio V <br />NAME <br />ADDRESS Y R y', <br />J. BOX 535 <br />:MERSET <br />FACILrrY BORN CRK & ELK CRK M <br />LOCATION , •IERSET <br />T r`nnP=0. 1=Y1=r` <br />p(QlrrenrJ NATIONAL POLLUTANT OISCHARGE ELIMINATION SYSTEM /NPDESI <br />DISCHARGE MONITORING REPORT (D R) <br />Z. (7 <br />PERMIT NUMBER DISCHARGE WOWS <br />MONITORING PERIOD <br />i IV YEAR MO DAY YEAR MO DAY <br />CO FROM TO <br />lJ h <br />Form Approved. <br />OMB No. 2040-0004 <br />MINOR <br />( SU]3P, MH ) <br />F - FINAL G <br />SEDIMENT POND TO SANBORN CREE9 <br />NOTE: Reed Instructiorve before C'xo+r+pletinp this form. <br />UN It <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. <br /> <br />EX FREOUE"Cy <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ###IEit ###IFtf# 5. _, ,?,:##IEIE i. O _/ Vt1' <br /> REQUIREMENT MINIMUM IV <br />x I mum <br />i <br /> , <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT tb#iE##ii ###•II## #af#u;hac. 3c, 70 <br /> REQUIREMENT ';r; I O DAILY MX <br />r SAMPLE <br /> MEASUREMENT <br /> PERMIT ## # ##### # ##> REPORT REPORT ':NCE/ "'RAB <br /> REQUIREMENT 30 DA AVG DAILY MX MOINT <br /> SAMPLE <br /> MEASUREMENT <br /> <br />_ n PERMIT sr 1r# ,'si - ,: 3500 7000 IJC'E/ Pit-,9 <br />UL- ti REQUIREMENT 30DA AVG DAILY MX i ]DPI T <br />AND ;;;{I= SAMPLE <br /> MEASUREMENT <br /> PERMIT -?•::... r> #?: ?•t? 20 ON'TIN ;. <br />c r c <br />: REQUIREMENT i f`!S-f I'lr? X = L N T <br />. <br />. <br />UND!._! I t C'' SAMPLE <br />MEIN' MEASUREMENT <br />- > PERMIT REPO- ' REPORT at>± ?? rr Nrr ! <br /> REQUIREMENT 3DDP c= n I LY MX <br />?inr•: ; <br /> SAMPLE p. ;. . <br /> MEASUREMENT <br />PERMIT ##?tit3ta< s!#ir-' = REPORT REP OR n <br />REQUIREMENT ;.'0DA AVG DAILY MX <br />AME/TITLE PRINCIPAL EXECUTIVE OFFICER I candy under pens y o Isw that this document and dl ¦llachments were TELEPHONE DATE <br />prepared under my direction w super .lelon In nocordane: with a system designed <br />N <br />to assure thus qualified personnel property gather and evaluate the Inrnrsnatlon - <br />of th <br />n or <br />wh <br />n <br />itt <br />In <br />ir <br />the <br />b <br />d <br />B <br />d <br />s <br />t <br />qu <br />m <br />e <br />. <br />ase <br />on my <br />e per <br />o <br />persar <br />o ma <br />age <br />em. <br />y <br />sys <br />_ su <br />tl <br />ibl <br />f <br />th <br />I <br />lk <br />th <br />i <br />f <br />n ` <br />h <br />di <br />i <br />th <br />fo <br />ti <br />I - <br />y mspens <br />e <br />or fa <br />er <br />ng <br />n <br />rma <br />orma <br />or t <br />em persons <br />rec <br />e <br />ft <br />e <br />n <br />o <br />? <br />• .• <br />- <br />- - <br />submitted ls. to the best army knowledge and beW. trove. accurate, and complule. <br />!! <br />. <br />- <br />NATURE OF PRINCIPAL ES(ECUTM <br />- I am aware that there are slgNnunt penalties for submitting false Information, SP AREA <br /> <br />OR <br />TYPED PRINTED Including the pondblay of fine and Imprisonment rw knowing violatloru OFFICER OR AUTHORIZED AGENT CODE 14UMMR YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reforanco aN attachment= horal <br />r n° L MIT APPL. I ED `OR <=10YRf 24HR PRFC TP FI,JFNT; <br />AND I. A. <br />c t: -.u?, r Ir.r?ni-ut v r,lIR nl^ , <br />PAGE <br />tom, i_ _. <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used C? iS•,8 4-? EfBt7T1. OF