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Form Approved. <br />PERMrTTEE NAME/ADDRESS (7.&,& Fwdw N..?Leer,aw tfDWrreeu) NATIONAL POLLUTANT DISCHAROE ELIMINATION SYSTEM I/NPDESI OMB No. 20404404 <br />NAME DISCHARGE MONITORING REPORT WMR) PlUF <br />ADDRESS =;IJDR MH) <br />J. BOX 53c-- PERMIT NUMBER DISCHARGE NUMBER - FINAL GUF' <br />t 1'JERSET = <br />FACILITY MONITORING PERIOD SURF RUNOFF TO N FK GUN I S R I VR <br />BORN CRK u ELK CRK h7I'?':: YEAR MO DAY YEAR MO DAY <br />LOCATION '-'ERSFT FROM TO _ ,, <br />MMES T. COOPER, EXEC V. NOTE: Read kIetructlorw before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREOUENCY SAMPLE <br /> <br />EX OF <br />Y <br /> [>< ANALYSIS T <br />PE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ###ik#3t #tf### t-r r 61. S ###### 9.0 NCE/ INSIT? <br />i REQUIREMENT M <br />M-'J M <br /> <br />MAXIMUM <br /> <br /> <br />ONTH <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT it?E#?i ass#a+ ##IF#i 3S 70 <br />- J REQUIREMENT ;V.) Q' DAlL MONTH. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ####r?it #*4#i? 3r ###s' REPORT REPORT NCE/ :"RAB <br /> REQUIREMENT 300A A`•/t. AILY MX MONT!- <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ####iSjF ###### ###IF## -SOO 7000 <br /> REQUIREMENT 30 DA AVU DAILY` MY h1QNTr <br /> SAMPLE <br /> MEASUREMENT <br />i. U PERMIT' r } -.. ><# p .K , it , r: t #?f 1 U Oh' I t G t? Arf <br /> E <br /> REQUIREM <br />NT <br />c_ Or?llU I ! Ltd' SAMPLE <br />I F " MENT Pt MEASUREMENT <br />1 Q 0 PERMIT REPORT PEP OP NC, r0 <br />;ENT GRDSc REQUIREMENT <br />QDA f= <br />; X l_`; x <br />MOi . <br />A:; D- R EA`;E SAMPLE <br /> MEASUREMENT <br /> PERMIT "SPORT ,## it fb <br /> REQUIREMENT . !?fT MAX MDf',i <br /> <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certr y under pens iy o law that thh document and all attachments were <br />re <br />d u <br />d <br />dl-tl <br />or <br />r <br />Hfo <br />In <br />d <br />ith ¦ <br />t <br />d <br />l <br />e <br />TELEPHONE <br />DATE <br />_ P <br />Pare <br />n <br />er my <br />on <br />fup <br />r <br />n <br />accor <br />ance w <br />rya <br />em <br />ss <br />gr. <br />to assure that quanlted personnel property gather and eeahrale the InfoemaUan <br />B <br />i <br />f <br /> mbnrtted. <br />road on my <br />nquiry o <br />the prrson or persona ho ~ate the syst, <br /> or those pera" directly respmslble for gathering Ilse Information, the Information <br />r I <br />r ° mbmllted h, to the best of my k m.rkdte and benef. trw, amtnte. and complete. <br />I ¦m aware that then are tdtldlkant Prnattles for oubmlllin <br />raise Informadon <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br /> g <br />, <br />TYPED OR PRINTED Inciuding the Possibility of nne and Imprtsontnrnt to,, kno.ing v)datlora OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference d/ attachments bar*) <br />E r r, LMT APP; T E^ ` nP - n'. ?:7.fiR ri <br />I.A <br />This 1S 3 4-part I4Fm. PAGE OF <br />EPA Form 3320 1 (Rev 399) Previous editions maybe used