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PIERMITTEE NAME/ADDRESS flmilu&iaratymeseste,,ml. (fD(f-..) NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTDA (INPOESI <br />NAME DISCHARGE MONITORING REPORT /DMR) <br />ADDRESS <br />Box S PERMIT NUMBER DISCHARGE NUMSM <br />_RSET <br />FACILITY TORN CRK s-< LL,; CRA NINLS MONITORING PERIOD <br />LOCATION RSET c YEAR MO DAY YEAR MO DAY <br />CCJ B1 FROM TO <br />IES T. COOPER, EXEC V_ P. <br />Form Aporoaea <br />OMB No 204:-a1 ; <br />t - I- I NAL. <br />SEDIMENT POND TO HUBBr <br />NOTE: Read Instructions hairs -nlstlna this }firm <br />NIS <br />PARAMETER QUANTITY OR LOADING <br />QUALITY OR CONCENTRATION <br />NO. FREOUENCY <br />OF <br />SAMPLE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT #ts##R# 6 <br />t) : 1 _.< <br /> REQUIREMENT r <br />M <br />I N I I`ILIN <br />MAXI MUr! r <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT ##### #ttiF#tr# ###### t? ; O ?:}_' ;,; ,,.: <br />E=t•t REQUIREMENT :i?}GA Asti- DAILY MX 1 MrlNT <br /> SAMPLE <br /> MEASUREMENT <br /> <br />1 0 PERMIT iF###t #3i tF#tE # t r ?c###i£ kF PFPC)Rr- <br />- R <br />i . h! { REQUIREMENT A : ` DA ! LY MX Ml7NT <br />TOTAL SAMPLE <br />i`5 T-F MEASUREMENT <br /> PERMIT iitF###tF It= #i?#### 3SOV 70170 NCE/ ?Rir' <br />B <br /> REQUIREMENT aODA AV( DAILY MX MONT' . <br /> SAMPLE a _ .. .. <br /> MEASUREMENT <br />o't 1 r) <br /> PERMIT ####t( #r: rf, - it -'I: t t: ###### i (? QN f ? GF F; <br /> REQUIREMENT <br />Gr SAMPLE <br /> MEASUREMENT <br /> PE <br /> RMIT <br />REQUIREMENT REPORT <br />30DA AVC4 REPORT <br />DAILY M?: iF?3r-cam ;?#)ftt## >. n## <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT +F##IF## REPORT <br /> ###Y";: it#iI### # ## # _I.'v =. 3 <br /> REQUIREMENT }' T fvlAy <br /> iui•iT! <br />NAMEfnTLE PRINCIPAL EXECUTIVE OFFICER <br /> <br />- ° b+ that Qs document and all attachments were <br />prepared under my direction or sups 6 On In sccordsty- with a system designed <br />t <br />th <br />t <br />f <br />l TELEPHONE DATE <br /> <br />- -- o inure <br />a <br />qua <br />i <br />ied personnel properly Lather end evaluate the Inth-rlallon <br />b <br /> eu <br />rottted. Stated on my Inquiry or the peso; or persons who manage the system, <br />th <br />d <br /> or <br />ose persons <br />imity responsible for gathering the Information, the Information <br />submllled * t <br />th <br />b <br />t of <br />k <br />l <br />d <br />-- <br />? <br /> o <br />e <br />el <br />my <br />now <br />e <br />ge and belef, true, attvrste• and c plete• <br />1 am seas that there are slgdficant penalties for submittin <br />f <br />l <br />e I <br />f SI <br />NA <br />R - ? ? <br /> g <br />a <br />n <br />ormation, <br />s G <br />TU <br />E OF PRINCSPAL EXECUTIVE <br />TYPED OR PRINTED Including the possibility of fine and Imprisonment for knowing vfotatko OFFICER OR AUTHORIZED AGENT AREAJ <br />NUMEIER YEAR MO DAY <br />•1Tn n !vM A at A T1 a] AC A \IV %/IA1 A T1-- CODE <br />V VrelfelLrelJ I1reV L/?r r-r?r?r+r.V.• v• n..• ?.vr?.rvreV 1/rw/an wl/GI NI ?Irw{.I////w/IIJ//wrwr <br />rJ ! i:- "LEABLE SOL I D5 LMT AP?L.I ED FOR = 1(?YF ^=,NR P 7, p r. <br />124Hf? -i <br />EPA Form 3320-1 (Rev 3/99) Previous edtbons may be used Ttu$ is a 4-O fpflll PAGE OF -