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PERMITTEE NAME/ADDRESS (7-" Fa idoy Nan dL"arrws (fD(farant) <br />NAME <br />ADDRESS <br />?l` L•rJ J <br />:.RSET <br />FACILITY _'ORN CRK & ELK CRK <br />LOCATION "-'R S, E 7 <br />'IES 7. COOPER, EXEC <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM WDESI <br />DISCHARGE MONITORING REPORT ID 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. 2040-0004 <br />NOTE: Read instructions b*fore completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREOUENCY SAMPLE <br /> <br />E OF <br /> X ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - •? :I. -- <br /> REQUIREMENT ^i , <br /> I <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT a n n x ,: ,: <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT itit r .- r' ;l. <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> S A MPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br />PERMIT <br />REQUIREMENT MAY <br />NAMElTITLE PRINCIPAL EXECUTIVE OFFICER I mrttty ° r pen¦ ly o law that this docomtnl and all alinehr,arnta wire TELEPHONE DATE <br />prepared under my dlrsrtlon or supervision In accordance with a system designed <br />to assurr that qualified penonnei properly Sather and evaluate the Information <br />submilled <br />Bawd on my In <br />uir <br />of the <br />erson or <br />erdu wh <br />mana <br />the <br />t <br />. <br />q <br />p <br />p <br />y <br />o <br />ge <br />sys <br />em. <br />- or th <br />o <br />directl <br />ibl <br />f <br />th <br />i <br />th <br />y respons <br />ose pe s <br />m <br />e <br />or ga <br />er <br />ng <br />e Information, the Information <br />_ submilled Is. to the best of my tnowie to and beW, Irne, aavrste. and complete. <br />I ate, a-are Met then art e=?In.a.t emltly for submlttlnr false Information <br />SIGNATURE OF PR1NCWAL EXECUTIVE <br /> , <br />r <br />d+ <br />d <br />^ <br />+ <br />TYPED OR PRINTED u <br />nr the podblut, o <br />arse an <br />impAsontment for knowing Hdattons <br />r OFFICER OR AUTHORIZED AGENT cooE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference ill attachments here) <br />M 7 ,'r•f>I -r, r-4 _?. i=ce ?C t..'T" <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. This is a 4-Pan form, PAGE OF