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NAME <br />ADDRESS <br />llnrlude Fucilih ~'umr/lornfiun if l~if/rrfnn <br />{a. $~?; f770 <br />r, ~ r, - ~, ~ , ~ : r., <br />FACILITY _i: Fl M~,":'= ~,Or1f~'..i_~. <br />LOCATION `aFNI {-- , a c i .~ -; c: <br />~v.AF-;' =CL_,ak~EA`I"Ir11V pt~,F•:I::~E~i' <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />MINOR <br />~ ~JLj13R s.jr <br />F - FINAL <br />DSGNO TO 7RIIItF!:~H <br />Form Approved. <br />OMB No. 2~0-0004 <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 /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE ~ <br />~ <br />~ <br />~ ~ _ <br /> MEASUREMENT t • / <br />- v <br /> <br />PERMIT ~.: - <br />- <br /> REQUIREMENT <br /> SAMPLE <br />' - ~ <br />r <br />~ <br />' <br /> MEASUREMENT - ~ <br />~ <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 arnit> unAer penulh nr Ins. that this ducumrtH and sll atWdcmenLs wrre <br />~ TELEPHONE DATE <br /> prepnn•d under m) dinY~linn ..r +uprn ision in aca,rdunce with n system dasignnl <br /> to u,atrr that gttalifird prt.unnel pmq•rl~ ~athrr and raulmtr the information I <br />' ~ <br /> whmiuad. ftuwd nn me inyuin of the q•rwm ..r Ix•nun, whn mnnugr the sc+tem. <br />nr thox prnana dirrcth rrsgrnsihlr for t;athrring lhr Inrnrmathm, the infurnmlion ~ <br />'•.~ <br />.~ ,,,///~~~ <br />~ <br />I <br /> whminad is, to the IrcQ or ms knew lydgr and Iti4ief, Irur, accurate, and rnmp{rte. $IGNAT E OF PRINCIPAL EXECUTIVE , <br /> <br />TYPED OR PRINTED 1 um aware that thrre are ,ignifir+nt penalties for wbmittink fulw information. <br />including thr ghsihility of fine and fmprisonmrN rnr Avowing sicduticros. <br />OFFI R OR AUTHORIZED AGENT AREA <br />C DE NUMBER <br />YEAR <br />MQ <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIVLAIwNS (Heterence au arracnmenrs Here/ <br />~~ <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be use <br />T1ii~ iss d-part fnnn. PAGE of <br />