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PERMITTEE NAMElADDRESS r/ndude £ariGh Saetr/location ij[kfJirrnU <br />NAME <br />ADDRESS r. 1, FN, I' `. C'd)~ COI'I~'L.E K <br />''EAI ''' C;O ~ 1 X34 <br />FACILITY ;~,A MII:)= COMP! i.i. <br />LOCATION ;BEN rr~ 8163` <br />r 3~AF?O, REi~I_A"'IAT1ClN rlF;rdA ~Fl~ <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES) <br />DISCHARGE MONITORING REPORT (D R) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR DAY <br />FROM TO <br />Form Appraved <br />OM8 No. 20.0004 ~ <br />F - FINAL <br />li 1 ~CHARGI_ TC7 1><aC7>= G <br />NOTE: Read Instructions before.•COmpleting this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ, FREQUENCY SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE _ __ -_ _ <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />~ <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 />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I ,<-rut., under pcnalt~ ..r la,. dwt thi. d,KUmem attd WI attachment+»err <br />d <br />' TELEPHONE DATE <br /> prepare <br />under m~ dirMion nr +upenision in ecrordrnce »Ith a s+stem designed <br /> d, a+surr that yualificd p<'rwnnel pn,prrh gather am! es aluale the inGrrnsatioa <br /> submineA. Rased .M m~ inyuin of the perum or penon+ »ho manage thr ay+tem. <br />~ <br /> or th,xc persons dirrcU~ raprmsibk for gathering the information, the information i 7 <br /> suhmiUrd is, to the ben of m+ I:no»ledge and txlief. true, wcurate, acrd complete. <br />I am a»arr thw them an• .i• <br />nilu~ant <br />enaltir+ for whmiUin <br />for <br />tion <br />tal <br />i SIGNAT E OF PRINCIPAL EXECUTIVE t 1 <br /> <br />TYPED OR PRINTED ~ <br />p <br />g <br />i <br />n <br />ma <br />. <br />including the p~,++ihibq ..f riur unJ impriwnmcm for Ana»ing +i,dwions. <br />OFFIEER OR AUTHORIZED AGENT AREA <br />CODE NUMBER <br />YEAR <br />MQ <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />r'~~? ~~ -~~~~_ * f-:L'~ ~ ilR -1!7YR, ~4H(~ F'R~'•^. YP EVf_"!~ST, T~,• <br />EPA Form 3320.1 (Rev. 3/99) Previous editions may be used `t'F11S IS a •~-pdTY fOrtll. PAGE OF <br />