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PERMITTEE NAMElADDRESS /hk•lude FucifiA-Aumr'Locuuo,r 1/Di(Jcnr,o NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />NAME COMPAI DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS r '• 1 '??? 1. NE <br />WEST IRST cTt?" PERMIT NUMBER DISCHARGE NUMBER <br />FACILITY NIDAD ELK MIN' MONITORING PERIOD <br />LOCATION YEAR MO DAY YEAR MO DAY <br />'TON FROM OR VL2 1 /9 j" TO -+ <br />•Yhlk Ct7V>? <<. tt. <br />Form Approved. <br />OMB No. 2040-0004 <br />% ovQf[ 0_1n <br />F - FINAL LAMA5 <br />RUNCFF POND V !PURGATOI HE RIVER <br /># X <br />NOTE: Read Instructions before comoletinq this form. <br />PARAMETER <br />QUANTITY OR LOADING <br />QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />+= F L UI f4 r :_'f:LD5S a!. `,!, REQUIREMENT M17 111,41 MUM <br />[J`Ti:l, T'`.' SAMPLE r-tr9i-t; <br />' JUSPFNT_.i ,-, MEASUREMENT <br />'D50'D <br />PERMIT <br />t_ r it k iF <br />- <br />=• Q sr <br />3G I <br />L r_ i <br />- .. <br />': FFL VI 055 t:'/=.l ' _ REQUIREMENT 1 3':!l -?+ Avt:; 'T i ; i <br /> SAMPLE <br /> MEASUREMENT <br />- PERMIT <br />- <br />• <br />7 <br />- <br />i Cl <br />? <br />- LU1 <br />N F 5 <br />S Vi <br />.; ..: REQUIREMENT s <br />-I ON, SAMPLE ? I - <br />tii r r MEASUREMENT 1 <br />;1045 1 PERMIT # it#Il# #= ref- - #### _ a 5 l 'T• •,:, <br />:_ FFLUrNT GROSS REQUIREMENT _ SODA AVG <br />I w .. - SAMPLE ;: -* it v t iE ic+ <br /> MEASUREMENT <br />r_• ' ^, PERMIT t: R?irki #- -r sF#e #s z irR# #ic 10 <br />,=LUEiV i Gi-75S Via. i_.`.; REQUIREMENT - t <br />IN C.i=iNCSL) 1 T SAMPLE xs*- st <br />i HRU TREATMENT PLAT i MEASUREMENT <br />7)50 1 0 0 PERMIT 1;FP0 RT r : - _ ., ? ##x:# iE ar _r. `'; , : -• <br />FF ? I-_IJENT GR057S '• :-+L ' REQUIREMENT <br />;aN T) G r; F Ar-' E SAMPLE ?4 1 :. -:• r: .; v <br /> MEASUREMENT <br /> PERMIT i, . `t iU= S q . „ .-r ^•:?3 t is ?.. ,: r; <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certify under penalty of law that this document and all anachments were TELEPHONE DATE <br /> d <br />d <br />i <br />i irection or supervis <br />prepared un <br />er my <br />on to accordance with a system designed <br />to assure that qualified personnel properly gather and c.uluate the information <br />J • , <br />,j j ` <br />?. <br />G t h <br />d B <br />d <br />f <br />h <br />- <br />h C`+ t <br />- <br /> sa <br />tmtte <br />ase <br />on my inquiry o <br />t <br />e per <br />ion or person% w ho tnamtge t <br />e system <br />' <br /> or those persons directly responsible for gathering the mt <br />orrnauon. the mfimruumn <br />` +uMnined is, to the best of my know9edge and belief <br />accurate <br />and complete. <br />true <br /> . <br />, <br />, <br />I am aware that there arc significant penalties for submithn <br />false infortrim -, SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED OR PRINTED g <br />includin <br />the possibility of fine and im <br />risonment for knowin <br />stolanon. OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br /> g <br />p <br />g CODE <br />UU NIMEN 10 AIVU CAI•'LANAI IVIV Vr A14T VIVLAI IVIVA (rleterenGe dtt diia Gnments here) <br />'=' I CD REPORTED. C) I L It< GREASE - SFr 1 Tq 1 D, P TC:c'•: e.: <br />i [i-?ITL I_: IED FOR <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. `l?? This. is `a 4-pan form. PAGE OF