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FERMITTEE NAME/ADDRESS pneifr F rs myMose bwar,an ((D(Qirrew) NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDESI <br />NAME DISCHARGE MONITORING REPORT (D RI <br />ADDRESS <br />j. I3OX 53`= PERMIT NUMBER DISCHAAGENuMem <br />IERSET MONITORING PERIOD <br />FACILITY 'BORN C R K S< L: L K '. Ft M ri i i <br />YEAR MO DAY YEAR MO DAY <br />LOCATION iERSET r ! FROM TO <br />MES T. COOPER, EXEC V <br />MINOR <br />(SUIIR MH) <br />F - FINAL <br />RUNOFF Tt <br />Form Approved. <br />OI+IiC No 20400004 a <br />la <br />IUN I S <br />X <br />NOTE: Reed kistrucdona before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREOUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE Y <br /> MEASUREMENT <br />1 () PERMIT ###iF## RtkPORT ! i #ttit## ##It### ;. tFit# J1?1{:1 / Z: ter+I <br />Gp REQUIREMENT INS7 MAX MONTH <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAMEfnT'LE PRINCIPAL EXECUTIVE OFFICER i Rrtny . r Pena Ty o I¦. that th <br />ared under m <br />direction or w <br />s <br />re is document and a4 ¦tiwitmenu were <br />erclfon In s rdanee with • system designed TELEPHONE DATE <br /> y <br />i <br />P <br />p <br />to astmew that quaMfled perwrTnel property gather and evaluate the inforsrrallon _ <br />- submilted. Bred on my Inqulry of the person or persons who ms¦n¦ge the system, <br />- <br />? <br />?? <br /> or those persons directly misordbk for gathering the information, The Information - / <br />' ? <br />" ; : - /% / . , , <br />' <br />' su4milled ls, to the lest of my knowledge and bellef, lrw, accurate. and complete. ?/? <br />;I <br />NATURE OF FRINCNAL P' ECUTIVE _ <br /> 1 ¦m ¦w.- that there are significant prndtfe for wrbmitdng false Infernistim O AREA <br />TE Including the ponibility or floe and Impr4rnmenl for knowing elolatIons. OFFICER OR AUTHORIZED AGENT CODE AMBER YEAR MO DAY <br />D <br />TYPED OR PRIN <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference a8 attachments hers/ <br />'LE SOLIDS I.MT AFFLIFII FOR '-10YR, 141IR PRFr Tn F`•)F1!T; <br />• EVENT-S!"-- <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. Tlus 15 3.4-Part form. PAGE OF