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PERMITTEE NAME/ADDRESS (7-& a F.ewry)V..?L«-ti n t(DWInw #) <br />NAME <br />ADDRESS <br />5! r, i': HIGHWAY i3 <br />f2 ' ij I <br />FACILITY ' L•,lYCI M 1 !AE <br />LOCATION <br />i. L.Y D. SANDS ,R':" VP OF DE <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM IrNPOES] <br />DISCHARGE MONITORING REPORT IDMR/ <br />PERMIT NUMBER DISCH GE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved. <br />M 11, P OMB No. 2040-0004 <br />( QI `. <br />1= - FINAL 'I1= <br />TAYLOR POND TO TA`:!-OR CRELV. <br />NOTE: Read Irwtrucdorw 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 /> 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 /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />L EXECUJiVE OFFICER I reruty under Penalty o aw that thl. 6-mrnt and au ¦Itarhments were -- TELEPHONE <br />NAME/TITLE PRINCIP <br />d <br />directlon or <br />t <br />i <br />d <br />A l <br />I <br />i <br />h <br />d <br />d DATE <br />. <br />er my <br />euper <br />prepare <br />an <br />on <br />n accordan,rr w <br />t <br />a sys <br />em <br />es <br />gne <br />h <br />l <br />i <br />to atrure t <br />at qual <br />f <br />ed personnel property gatMr and evaluate Ike Inrnrnatlon / . <br />I <br />i <br />aubmllted. Based on my <br />nqu <br />ry of the person or Persona who manage the system, <br />or lhose person directly responsible for gathering the Information, the Information -?/ ` J I•- J? <br />(_ <br />¦rbmilled K to the best of my knowledge and belief. Irot. acsunle. and complete. <br />INCNAL EXECUTIVE <br />I <br />T <br />R <br />P ?- <br /> I am aware that them are significant penalties for wbmltting salve Inforsstatloo, S <br />GNA <br />U <br />E OF <br />R I <br />TYPED PRIPITED <br />OR Inr4udtng the poasiblNty of fine and lurprfanwmenl for knowing rMlations OFFICER OR AUT14ORIZE0 AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference sll •ffechmenfs here) t' <br />'414R PRECIP EVENT IS CLAIMED- IF CLAIM APPROVED <br />MENTS - SEE I. A. 2. - <br />°P( LNG INST RUCTION:, <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used ?ClS'? : Thl4`it a 4-pa Ft feirm. PAGE OF