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PERMITTEE NAME/ADDRESS (7.,A kiarfbgglv..arLxatrew I/?t0-V`? NATIONAL POLLUTANT DISCHAROE ELIMINATION SYSTEM //NPDESI <br />NAME ?V - DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS <br />ulJ.•. i 7 ??? ???G?Sa?e?y PERMIT NUMBER [;I11.AIGE NUMBER <br />FACILITY I ` o a?N d MONITORING PERIOD <br />LOCATION I YEAR MO DAY YEAR MO DAY <br />tR <br />FROM TO <br />Ii <br />Form Approved <br />OMB No. 2040-0004 <br />F - F I NAL ? <br />RUNOFF TO td FK GUNNISUN RIVER <br />NOTE: Read irestructions Woe* completing this, form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREOU SAMPLE <br /> F <br />OF <br /> <br />< <br />? EX ANALYSIS TYPE <br /> e <br />! AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT #'s ;r .:• y <br /> REQUIREMENT r! `• T I'iVfl'I <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT a <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT t F,r ?M# ;f #yi <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - ### r= ?::r -...:•,; ... <br /> REQUIREMENT %A <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT ! I?4? FA;? <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER a canal) under Penalty o low that this document rand all euachments .ere <br />TELEPHONE <br />D ATE <br />prepared under m) di-II.. or supenifon In accordance with • s)flem designed <br />to aware the, qu-tirled p,rsonnel Properly Lather and evaluate the Inforwtatlon <br />.rbmitted. eased on mr Inquiry of the person or peraoe, who w onate the -stem. <br />or those pereme directly respon able for gathering the Informallon, the information '. % r <br />submllted W. to the best of m) knowledge and bellef. true, .Rural., and complete. <br />• <br />I am aware that there art significaM Penalties for submitting role, Inrormaden• SIGNATURE OF PRINCIPAL EXECUTIVE - - - <br />TYPED OR PRINTED Induding the poadblBty of one and lnrprhonnwnl for knowing violations. OFFICER OR AUTHORIZED AGENT AREA NUMBER <br />CODE YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference a# attachments herel <br />-NT T•f! t c,(1(.' c; 'L T,- `T? <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. This IS a 4-part fOt7T1. PAGE OF