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PERMITTEE NAMFJADDAESSgw*,.FmeftN mWl?arfwl/nIQIn.t; <br />NAME <br /> <br />ADDRESS <br /> <br />- -IF_EK=-P cri <br /> "OLOWY0 NINE <br />FACILITY <br />r -i E= K E R c G <br />LOCATION <br /> KELLY D. SAhIDFP.S, "r OF <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDESJ <br />DISCHARGE MONITORING REPORT (DMRJ <br />OF, Form Approved <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />&O FMQ Y DAY YEA DAY; <br />B: <br />FROM '771 TO <br />M I NII ., P OM5 No. 2040-0004 <br />! SUER JC ? <br />} - F * NAL <br />GULCH A SEDY POND/GOOD SPG5 CP <br />NOTE: Read Instructiorw ballots completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, <br /> <br />EX FREQUENCY <br />0? SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />' SAMPLE <br /> MEASUREMENT <br /> <br /> <br />L IJEIVT GRf15t? `,:_ . PERMIT <br />REQUIREMENT <br />""ODA AVb ' <br />E.-A I LY M : <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REOUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT 1 <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 />t canny u r pen. IT of L. that UN document .rd 1A albchmrnle were <br />d TELEPHONE <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER <br />re <br />.nd Yrtdet m <br />dlrectlon or A <br />ere1?01t In atrordan <br />el,h . t <br />tlem dd <br />i <br />DATE <br />p <br />p <br />p <br />y <br />ct <br />y <br />p <br />e <br />?r to aware thtl quaNfhd personnel properly gather and evaluate the Inforrn.llon <br />" <br />eob"lod. enard an ,n.1"W ry or the permet or pervorn .ho manage the eylitn% <br />?'? i <br />or thole penom directly rnpondb4 for Lathering the Infornollon, the infornolMn / " 2 IJ ?. I -?? <br />?, <br />?//}?- <br />lo <br />?,C • ?' '7 <br />j <br />, <br />/ <br />mbrdtled b1, to the best of my k",ek4 t and bebef. Irv., arsvra/t. and tom <br />/c ( I .m a <br />W -hrrrtn <br />SIGNATURE OF PRINCIPAL EXECUTIV <br />lflt <br />rtt <br />M <br />m <br />i <br />I <br />C <br />TYPED OR PRINTED s an th.l (he, .R t <br />a <br />Pe.. <br />ng <br />Ln <br />int <br />et <br />nformation. <br />InAuding the posdb111te of fine and Imprisonment for tno.ing viol*Uo <br />OFFICER OR AUTHORIZED AGENT AIIIA <br />CODE NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION Ur ANT VIULAIIWNS Iffeforenceoff arrocnmenysnaref 'R PRECIP EVENT IS %LAIMEi}. IF CLAIM APPROVED " ilf3CTJ. <br />EPA Form 3320-1 (Rev 3199) Previous editions may be used nl This FS-i1 4-IYAT'I TOI•nl PAGE OF