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PERMITTEE NAMElADDRESS ,Inchrr4• Focifiry• Nnmr.4l,carlon ijDi,~erenff <br />NAME ~.. <br />ADDRESS - ~ ' ~ - . <br />.f, . <br />:. _ ~ _ <br />FACwTY <br />LOCATION . , - ~ '_'• 164 <br />~ncq <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO OAY YEAR MO DAY <br />FROM TO <br />Fonn Approved. <br />~ OMB Nv. 2040-0004 <br />R L7W ? <br />F I MAL ~~ f3t.Al4 <br />T17 5r;'a! .i_ I C]i~i GULCH <br />NnTE: Read Instructions before comDletinq this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION Np. FREQUENCY <br />OF SAMPLE <br /> ~ TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />i SAMPLE <br /> MEASUREMENT <br /> PERMIT .~.~.::. t • . <br /> <br />- - <br />REQUIREMENT :c~~; .,, <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> <br />i= l: `~+ ' REQUIREMENT <br />`i. ~ SAMPLE • <br />-I_~`= i" ' ' ;' -. :, MEASUREMENT <br /> :.i <br />~E~- u . ~ <br /> <br /> <br />- PERMIT ; <br />r . <br /> <br />" <br />+.: <br />' j;.:'; REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - - , .- _ <br />_ REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />'. PERMIT ~ i,-. 1: .. .. ., ri`. <br />- REQUIREMENT _ '.~:~ ,=.`'C= - ..;_.Y r f]CII~ITH <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT r , - ~.. _ ~ : ~ •; , . <br />- REQUIREMENT ~ •`i • •. `~ ~: - ~=E~' T <br /> <br />,_ ~- <br />SAMPLE i:..... _ <br />ry(~U " -+;; . MEASUREMENT <br />_ PERMIT •.~ ~ r <br />_ +.~:_ ~-~ <br />• REQUIREMENT ~ ~= Ft = ' <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER t «ttir:. ,~,,,.:.~ ;•.ntdty of t:+w drat this dcxutntat an+i .. ::~i tchmen:: were TELEPHONE DATE <br /> preparc.i .~ ~ ,,r my dimcuon nr supenistun to ~ccurd:m..-~: .+ nh a system dcagncd <br />- <br />r ~~ aFRare ; ~~:c talified r noel ro rl;. tthaand c.a ;etc the tn(ormatitm <br />inywry of the pcrun or <br />erxm n manage the c}stem <br />.uhmitt <br />4•d n m <br />i H -- •--- <br />`' <br />' ~ <br />- <br />~ ~ <br />/~j <br /> , <br />y <br />p <br />e <br />u <br />~~r thole Penor dt. itith res-Iwnsiblc for gathering tfie i~ ~ nruion. the in fimnaunn ~" ~ <br />` <br />~,f6G~ , r <br />: e and b <br />and a,m <br />lctc <br />f <br />o <br />led <br />t <br />l <br />- <br />t <br />k <br />li <br />' <br />( ~ - ~ -_ `" <br />~ ." <br />! f o <br />w <br />g <br />p <br />cu <br />x <br />s <br />my <br />n <br />e <br />tn+ t w+ <br />c, <br />xtti[ted ts. e.: tl <br />e SIGNATURE OF PRINCIPAL EXECUTIVE - - <br />~~ <br />TYPEA OR PRINTED (am ew.erc th:+::i::re are stFnificant pcnalucc (or submnnne r.t~se mfonnarnm. <br />including the pos~indtty of fine and impn.,mm~rnt for knnwin_ . i:~lan.mc OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO OAY <br />CG~.9MENTS AND EXPLANATIC7N Vr ArvT vlvu+l wrva Inererence au nua~,r..,o,,.~ .,Cre/ <br />EPA Form 3320-t (Rev. 3,99) Previous editions ma , <br />i Ili. is ~: -:-hart C~~r;;; ..~~ ~ <br />