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PERMITTEE NAMEIADDRESS (Include Facility Name/Location if Different) <br />NAME i :i.. 7i I'.l1 i., is r: HDWA`' E::DAL MININC3 <br />ADDRESS I i`•S <br />7--: 'STIE 207 <br />e 'u?L.z !?!CiO..D C.,0 f: "U it <br />FACILITY ?t`•Id $'': i i' T? <br />LOCATION €?::, 11 ??' I ; #_' tt'I t=}? <br />-r•'•r•a: 'Y?• . _ i i•-:?S',-i. ?=:tz? ".=7?3i' ?3`,lt:,.7&4iF^rl~7 <br />Form Approved. <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) OMB No. 2040-0004 <br />R) I <br />?+ ?DIISCHARGE MONITORING REPORT y (D!11e [MSW?q?? r+ <br />PERMIT NUMBER DISCHARGE NUMBER F F I N AL u t <br />SLIF?~'l CE- FlfNOF F TO TROUT MONITORING PERIOD <br />YEAR MO DAY YEAR MO. DAY FROM TO ! ,.1' r 9s kfi i`•(Q D i 5C".1r;AR0F. I .?. I s4. } j <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> AN <br />ALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />`•?} SAMPLE ?t :?t?k # i =1 ?r 7 :; <br /> <br />Z Ye l,tf 3#?1 <br /> <br />3 <br />3? 1w + <br /> <br />1(} <br /> <br />lhS1T?1 <br />I <br /> ME <br />T i.U c <br />, <br />J <br /> ASUREMEN <br />00,4100 4 C) PERMIT L tE = + t x:s. <br />? r sr :? :.13f fa au , i 7t i <br />;~ F1_iJ 17r 1 1. r7 l:?+^ VrvL.'.13 REQUIREMENT w s t?8 t'1 €f'q I MA", ,?i <br />t.w '. i 4_. .?_ -.., _ i t <br /> <br />rM j <br />,.r.? __ t, ;: _• , , ow-. <br />SAMPLE x <br />']?+"n' .n' "n ?i„S.C ".i..?t. X..?( ^. t' "!i"):' :' T?' :•I' <br /> <br />J <br /> <br />4 5 \ 7 <br /> <br />2 X <br /> <br />G?pa <br /> MEASUREMENT 30 <br /> <br /> <br />M <br />rt i ' t? r) <br />S, :I ._ PERMIT # f :? . <br />r -, <br />a•=? w .1,w <br />a ••;} <br /># s• •x <br />4 `_:; <br />«?t .. , r <br />, r A is <br />FF*Fe._i? t' l O _ t '. ,j <br /> <br />it It i.???tiJY.J5 .? Wt?1 ?.." REQUIREMENT <br /><.: J?V <br /> <br />?7 <br />:.? ' , <br />t' ? ?!*? <br />11Grr3,.. <br />' OP, T i i <br /> <br />SAMPLE <br /> <br />C) 25 <br /> <br />615 <br /> MEASUREMENT <br />f` rd +r s PERMIT PtDlRT' C ` .t .ts.F?i3 <br />FF '1_.ik1 €vi t C,tiJ ;'=r AL..l•?r <br /> <br /> <br />r <br />'; <br />REQUIREMENT <br />) <br />A AVM <br />rf <br />b t'? Y M, <br /> <br />1";L.,r> <br /> <br />rat i€'•'`i 1 <br />M"Ip SAMPLE , # # f...:z. . _ :'.•ir ii ? :. <br /> <br />JS <br />40 2d) <br /> <br />Z <br />i?> <br /> MEASUREMENT <br />C 1 1 i i; ? PERMIT # cti # < .. n r'k'a i*;t• ?i•*• R :F' .")F? } ti t slr <br />E--:F'FL.k.IEN-E ; R rht.; VA1.. Ur REQUIREMENT AVG l Y 11?. Vol./L_ ; li )Gti ! ! <br />P,3 (ice ' SAMPLE zi 31?}3d #;i la :; ,'•.}. t : '. ( ,.a <br />DISSOLVE MEASUREMENT ly. ? ?O <br /> PERMIT r, ?t <br /> <br />?: <br />0 ! <br />C..?:OGS VALU-1 REQUIREMENT' :r. CP, AVG I.?e-?`1:? UG/L <br />0IL l+ '`='%? } Y', ::) <br />.. <br />SAMPLE 3f•3i••fF• •. .:} ','t'3d•it t•` :; •:??!•.:k:'•.Y=k 'ti• .x„^'kx4• { d <br /> <br />^I?a <br /> <br />h rA <br /> MEASUREMENT <br /> <br />a _ J <br />L ^? ' C it <br />?,:I?I <br />PERMIT x..fst--A•?`st ? s-;e:'F'?d'_ '?# f? -.:a,#•.t.'Lro, %i•:•i•a°kff5t 3t.? t (J 9 kt'?I •af?:FiL1 <br />. <br />EFFL.+JE('3" _ ?(wSS) VALVE REQUIREMENT' 1.N'51" MAX ('G/ <br />€ °" ft,j T o jQ,-%!I. J 1-T OR SAMPLE I. ? 1 't ; it u ? ? is ;t • yt x ? n ? a it ,t <br />"€HRU t A i 1"1,.13 ! PLAN I MEASUREMENT <br />S- r4 110 is x PERMIT <br />IMF 1"`JE€tltwt..iJ REQUIREMENT : t =°, •., :., . _.` t ? <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certify under penalty of law that this document and all attachments were TELEPHON E DATE <br /> <br />-'t C? ( <br />` \ `?• <br />l V S CJL <br />C prepared under my direction or supervision in accordance with a system designed <br />to assure that qualified personnel properly gather and evaluate the information <br />ersons who manage the system <br />of the <br />erson or <br />Based on m <br />uir <br />b <br />itted <br />in <br />- <br />1.? <br />i <br />U C , <br />p <br />p <br />y <br />y <br />su <br />m <br />. <br />q <br />or those persons directly responsible for gathering the information, the information <br />submitted is, to the best of my knowledge and belief, true, accurate, and complete. <br /> <br /> <br />IGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />??r' G I <br />JV? 1-? v <br />l,l '\ <br />1 U ??,j/ <br />1 <br />- 4 <br />TYPED OR PRINTED I am aware that there are significant penalties for submitting false information, <br />including the of fine and imprisonment for knowing violations. <br />g possibility g OFFICER OR AUTHORIZED AGENT AREA <br />CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Rererence all attacnments nere) <br />f'-lit T W*;L._, BE WAIVE£r FOR PRE-- FEVElk - EE 1. A. 2, P0. "i' FOR REQUIREMENTIS, <br />QR'-1€d+ ;' AJM? 7c C. 10; !"G". Q. <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. 001 9 / f 0Ttii'!7isi A *. &5fOrm. PAGE 10F