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FERMETTEE NAME/ADDRESS (?-b. r Fw'IeryMs. tLocwtow ((D(arrwu) NATIONAL POLLUTANT OISCHAAOE ELIMINATION SYSTEM NPDES) <br />NAME DISCHARGE MONITORING REPORT (D R) <br />ADDRESS <br />BOX PERMIT NUMBER (ISCNARGENUMSER <br />'I G <br />MONITORING PERIOD <br />FACILITY APPER t11IvE YEAR MO DAY YEAR MO DAY <br />LOCATION A I G CID 3!. FROM TO <br />:?Yi'10FdD G. DU BOIS, PRE,/Gt <br />Form Approved <br />OMB No 2040-0004 <br />M1NI <br />F - FINAL MOFA1 <br />DSCHO TO E. M I DDL.E FLUME GULCH <br />NOTE: Reed Instm done before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. <br /> <br />EX FREOUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />- <br />fix <br /> MEASUREMENT " <br /> PERMIT REPORT <br />atF?Fst <br />; :fit Its <br />#3F it##?1 <br /> REQUIREMENT INIST MAX <br /> <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 />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I rertily under Prna iy o h. that Ihh dorvment and sly atlarhmenb were TELEPHONE DATE <br />Prepared under my d1mr1lon oe supervbiun In accordance with a system dadgntd <br />/ to amm that fuaMM1ed personnel Property gather and evaluate the Information ,. <br />Bred on my Inquiry of the Person or penom who manage the system <br />/ <br />sobMiled <br />/ <br />. <br />, t- <br />L <br />/ <br />• <br />?y~ ' <br />t? <br />or those permos directly mpo"ble for gathering the Information, the Information <br />1. <br />(r <br />??': • <br />/ ' , <br />? ??' / <br />. i , <br />" <br /> <br />the best or my knowledge and better. true. armnie, and compkie. <br />> <br />. <br />! submitted b. to <br />- • i . ' <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />i <br />l <br />i <br />I <br />` <br />, gnificant pena <br />tie for aubm <br />tting robe <br />nformation. <br />I am aware that then: am s AREA <br />TYPED OR PRINTED IrA*Wing the poalblNty of fine and Imprhonment For knowing vioiatlorm OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS /Reference sX attachments here) <br />rGT?LE" SOLIDS L.TMIT APPLIED FOR 10YR, 24HR PFFCTP EVENT- <br />I T OR ! i <br />iS a+ a?tt IQrrn. PAGE OF <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. 11RS . @_ ,., <br />try