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PERMITTEE NAMEJADDRESS flufudr Fert7iry Aamdluratian iJUiJJornti <br />NAME ~ .- <br />ADDRESS .. _? i ti M ~ ~ : , <br />~~s .~ <br />' Rl~' 1. ~~ £ i 4~'i• <br />FACILITY i 7U1't 1 ~©h# !vi I f•IE <br />LOCATION A CO 8 i 424 <br />• ~ ~ANCE_;,W_AC~>".r t'11I•fE MANAGER <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 MO DAY <br />FROM TO <br />Form Approved. <br />OMB No. 2040-0004 <br />r arartt~. <br />"lIN~ DRfVG 70 TUTT'Lr pRAW <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION t~1O• FREQUENCY SAMPLE <br /> OF <br /> EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE ~" <br /> MEASUREMENT <br /> PERMIT i=;~ ...... - . IZEr'(.,RT _i•}~E: <br /> REQUIREMENT ;i',1:~ i}li;i_'T I`l:~ -'1C~~;T` <br /> SAMPLE ~ ' <br />' MEASUREMENT <br /> PERMIT :; ;.~ ::. ~ i t'~f'OFtT - ~~~ <br /> REQUIREMENT A'J4 t7A I L. Y i`l :~ `: ` ;;`.i <br /> SAMPLE - <br /> MEASUREMENT <br /> PERMIT .. +r#-a:.-" ~_~ -.. REP ART - ~ - . <br /> REQUIREMENT - r A 3 i i•1 X _, <br />' SAMPLE _ _ <br /> MEASUREMENT <br /> PERMIT f - . -. FrF_PORT _,~~ , i .-... -.; <br />-' <br /> REQUIREMENT :: _iDR A'JF: v I`l~; _, ~ . `• <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 l rrnr. anekr penaltc arlaw that this document and all attachment were TELEPHONE DATE <br /> prepared under m. dim1ion or supenisirm in accordance with a s~atem designed <br /> <br />_ -. <br />to assure that ~rralified personnel proprrh iprther and c~aluate the information _ <br />' <br />- -- <br />~ subrniurd. Nord on m. inyviry of the prrwm nr penons wIw manage thr yr+irm, <br />~ <br />/ <br />_ <br />" or thoyr Ia•non+ directly raponsibk for gathering tlrr information. the information - - - " <br /> <br />~ r <br />~, +. ` ! <br />~ <br />+ubmittnl n, to the best of m. knowledge arrd belief. Iruc, accurate, and complete. <br />w <br />I <br />l <br />t th <br /> <br />SIGNATURE OF PRINCIPAL EXECUTIVE r <br />- :.l <br />` <br />- <br />.- ~~ <br /> <br />~ :.m a <br />are t <br />m <br />rrr arc. nifkant <br />FR penaltio for submitting fare {ofnrmuliun, <br />TYPED OR PRINTED uialuding the pocsibJity of fine and imprisonmem fnr Anowing.irrlatiara. OFFICER OR AUTHORIZED AGENT AREA NUMBER YEAR MO DAY <br />rt)MMFNTC enln cYat etuerlnhl nc nhly vent nTtnnle ia,.s...,,....,, ..rr ....,.,.~....._.., ~___r <br />EPA Form 3~i0-1 (Rev. 3/99) Previous edihons may be <br />I'ii~ i. a - ~:~~~ luny. <br />