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PERMITTEE NAME/ADDRESS (7ma k F-4hoyM-maLx.fi w ((D(dwwr) NATIONAL POLLUTANT DISCHMOE ELIMINATION SYSTEM (NPDES) <br />NAME DISCHARGE MONITORING REPORT IDMRI <br />ADDRESS <br />I3OX 1 PERMIT NUMBER DISCHARGE NUMBER <br />IG <br />FACILITY "PER M I Nr= MONITORING PERIOD <br />YEAR MO DAY YEA O DAY <br />LOCATION -'G CO -? ` FROM TO <br />rMOND G DU BOIS, PRES/Gi' <br />Form Approved. <br />OMB No 2040-0004 <br />MINOR <br />(S(JBR .JC ) <br />FAT <br />DISCHARGE TO FLUME"IGULCH <br />NOTE: Read Instructions bsfors complstinp this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY <br />OF SAMPLE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE <br /> SAMPLE <br />MEASUREMENT <br />) <br />V 1+1f' <br /> / 7 <br /> PERMIT #n>fsltt REPORT , ?t##? i:x#### ###### IS <br /> REQUIREMENT 114ST MAX <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER 1 mrtuy -rider penally o I... that Ihb document and all sitwhmrnts were <br />Prepared under my dlrectlon or witw-Won In accordance with a sy.leen designed TELEPHONE DATE <br /> <br />f. / ! <br />) , /? to care that quatined personnel property gather and e•aluatc the Intormallon <br />wbmltled. Bred on my Inquiry of the person or persoeeg who menage the,y.tem, <br />I or [how persons directly respor..lble for gathering the In?ormation, the Inrormatbn <br /> wbmllled I1, to the best of my knowledge and belief, true, a rule, end rompWe. i <br />T ' I am aware that then •m s/gnlnunt prnaltles for mbmltnng f.bw Inrnrmatlon SIGNATURE OF PRINCIPAL EXECUTIVE <br />TYPED OR PRINTED . <br />including the po,dbnitr or ilm and imprisonment foc king •lol.Uor OFFICER OR AUTHORIZED AGENT <br />AREA <br />ODE NUMBER <br />C <br /> <br />YEAR <br /> <br />MO <br /> <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS IReforence all attachments herel <br />rn,j;t }- _nl ?r}c rn,Y -T AF'P!_IED FOR =I0YR, r4HP PPFr - <br />EPA Form 3320-1 (Rev 3199) Previous editions may be used. hIs,$4_'[ af(.fpf ITI. PAGE OF ?,