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PERMITTEE NAME/ADDRESS ilnclude F'acilur:~'amr/larunion iJUiJJtrtnrl <br />NAME <br />ADDRESS <br />FACILITY _ ` ~ ;_ ; „ ; , - <br />LOCATION - ~ C CJ E i <br />i_.kNGE WALE, "I.i'dE '-iAf4AGFR <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 />~~ %1rZI'• <br />~~ <br />~-. <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ, FREQUENCY <br />OF SAMPLE <br /> <br />EX <br />I TYPE <br /> ANALYS <br />S <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - ,: ~ ;i sr k• -: r.• :; , :r t t<~~.. , t s~ _ t.,-: <br /> REQUIREMENT _.•' - ~'~RTE- - - <br /> SAMPLE " <br /> MEASUREMENT <br /> PERMIT , :---.. ~; s<•.t ~•I•s#•ir#~ ~ ~ c ~ s: <br /> REQUIREMENT - <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ,~ # ~ ; ,- fr x :r - .- . -- s r <br /> REQUIREMENT ~ i'i(;k " <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 certiF under penolh unaw mat this d~Katnem and all atrocnmenec were <br />dirrctxm nr zuprnicinn in acrmdance w-ilh a c~ctrm dcikned <br />rr <br />and under m TELEPHONE DATE <br /> p <br />~ <br />p <br />to assure that ytwlibed perwnnrl pruperi~ Kather and rculuaa~ the inhumadoo ~ c <br />.- -- , _- , submitted. Rued un my inyuiry~ id the pervm or prrvm. xho munatte the s)elrm. ( ' <br />~~ M IIff14r prnMmz dlrectls rnpm.itrle (ur ~a[herinP the in(nrmrliun. Ihr in(ormotfon ~•- - - , <br />-~ i ,{' <br /> kt <br />d , <br />! - l~) . u- <br /> <br />` submitted iz. to 1M hest u( m. Anow ledge and belie(, true. accurate, en <br />contp <br />r. SIGNATURE OF PRINCIPAL EXECUTIVE <br />' ~ ~ 1 nm aware that there arc s{RniOcunt q•naltin for mbnvttiuK fut+e information, AREA <br /> t fnr km~hin <br />cl<da6uns <br />ihllin <br />f f <br />d i <br />is <br />I <br />l <br />di <br />h OFFICER OR AUTHORIZED AGENT NUMBER YEAR MQ DAY <br />TYPED OR PRINTE x <br />. <br />ine an <br />mpr <br /><mmrn <br />ne <br />u <br />nC t <br />e plrc <br />o <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments ~erel <br />;,5 <br />- ,~ t_~ <br />EPA Form 3320 t (Rev. 3r99) Pre~ous eddiorts may be used. Thls JSa 4-pisrt tOfITI. PAGE <br />