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PERMITTEE NAME/ADDRESS pnrrbFrefgNn.?Lerrrw I/Dyb.w.q <br />NAME <br />ADDRESS <br />i ux S35 <br />-RSET C <br />FACILITY 40RN CRK & ELK CRK MI <br />LOCATION _RSET C <br />+MES T. COOPER, EXEC V. P <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDESI <br />DISCHARGE MONITORING REPORT (D R) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved <br />OMB No 2040-004 <br />Nic <br />NOTE: Reed kwtructiorw before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. EREOUENCr SAMPLE <br /> OF <br /> EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />MEASUREMENT <br /> <br /> PERMIT - <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT n,- ,. # x#rE?-e ;. ;i` <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT - <br /> <br /> PERMIT = e <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT ?I# <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT R I" c <br /> REQUIREMENT t:111A <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> <br />PERMIT , <br />REQUIREMENT <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER I mrtily under penalty ° law that thla doccement and all allachmntts were <br />TELEPHONE <br />DATE <br />prepared under m7 dlrectbn or super.fslon In aeeordante with • system dediined <br />to assure that qualified p rsonmil property gather and evaluate the Infewwwllon <br />submllled. based en my Inquiry or the perwn or penoen who manage the system, <br />or those penws direclly reapordbk ror gathering the Information, the Inforwaillon <br />- -' <br />submitted I& to the beat of my knowledge and belie(. true, accurate, and toenplele. <br />1 am aware that then are significant penaltla for submitting fain Inforneatlon <br />SIONATURE OF PRINCNAL EXECUTIVE <br />TYPED OR PRINTED , <br />IncluAing the posalblilly a Ilm and Imprbonment For knowing ablation. OFFICER OR AUTHORIZED AGENT <br />ARE <br />E NUMBER <br />CODE <br /> <br />YEAR <br /> <br />MO <br /> <br />DAY <br />] <br />COMMENTS AND EXPLANATION UP ANT vwLA I IL)N5 Woforence e/f ettschments herel <br />7- In- <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used This is a 4-Part form. PAGE OF