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FERMRTEE NAME/ADORESS(Inr4/r fleWy N../Larrlon l/DIQil.wn) <br />NAME <br />ADDRESS ._ ;':~ f <br />90X 4t-~ _; <br />';CIA •:~~~ 81428 <br />FACllrrv ~ NO. :~ !1 i NE <br />LO~~ : Y A ~ t] 81426 <br />• 1 nM n ncnn 10 MTf\IC Mf1C1 <br />NATIONAL POILUTAHT DISCHAAOE ELIMINATION SYSTEM //NPDESJ <br />DISCHARGE MONITORING REPORT (DMRJ <br />PERMIT NUMBER ascHAr~aE wuMeEn <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved. <br />OMB No 2040.0004 <br />M T. NOR <br />(SUER MH <br />F - PINA <br />SR; AEER <br />NOTE: R~~d IrNtrurtior» b~lor~ compl~tk-y thh form. <br /> <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, <br /> <br />EX t*EOUENCY <br />of SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~#?~~#-R «..>.-~~,rst;s :•t _., ' 1 <br /> REQUIREMENT , <br /> SAMPLE <br />',i~. <br />MEASUREMENT <br />,^~-,?O PERMIT •>•~~##~ .~-: ~•~:F•~. :.. ...., <br />l )~!\1 I REQUIREMENT ~~' , :. :' h;i N ~ti <br />~~ , SAMPLE <br /> MEASUREMENT <br /> PERMIT .,~ ~••>s--'r-# ,y. -. :?_I'~ :~~'~?f-., iuCE% -':~. <br /> REOUIREMENT ~; . f ~ t•~;; f iC~;~~T{- <br /> , . <br />, SAMPLE <br />(f;S MEASUREMENT <br />=S ' PERMIT .:. Y#~~ {..~ r . - ,.-.i-..-. ~ ~~-. i•: I'~. •,~ <br />'i=NT REOUIREMENT - <br />: i-. ( ; , <br />'L <br />AP!i~i SAMPLE <br />_. MEASUREMENT <br /> PERMIT .>t.., :. <br />- REOUIREMENT ~ ~_ ' <br /> SAMPLE - <br />,. MEASUREMENT <br /> PERMIT ~:` ~I., ::• , .... <br />_ - ~` .,,; <br />_ REQUIREMENT <br />_ : jf_'~ i~,y <br /> SAMPLE . -, ~ _, .__., <br /> MEASUREMENT <br />PERMIT - - ~r x~.;: :s ~ti:i~'l; ~-; mil' RT <br />REOUIREMENT ~.3!? I R ,,~ ~ TR ~i, <br />NAME/T1TLE PRINCIPAL EXECUTIVE OFFICER 1 te"i1i " of oe"l IT ° I.. In.l lhH dervmem .nd .11 .IlKnlnenla .~ <br />TELEPHONE <br />DATE <br />preplnrd ender Inr dirtclbn or fuPel'•61on In ertrordlnlr rilh ^ rrelem dol~ned <br />le lewre Ihll qulMfkd penonnei /ropeAT plner lnd e•Julle the Infer+nlllon <br />enhr11111ed. sued DA m) Irpulrr or the person or pen/m whe minl/e the e)eleln• <br />er Ihoee perlem dlretll~ rnpoMlDk for (ltherln~ the Infonnlllen, IM Inrorn~lf°n <br />/uhlydlled lf, b the 4et1 of m~ knowYd~e lnd AtMer, Irve, ert<vrne. lnd compkle. -. <br />l <br />nln <br />•IONATURE Of -plNdrAl El(ECl)T1VE <br />l <br />l <br />l <br />I ' <br /> ( <br />eM <br />I lT l~lR Ihll lhfre lR y <br />penlltkl <br />ar eeDrllllt <br />n~ fKw <br />nrenrutlon, A A <br />TYPED OR PRINTED Inrrl.dlni the podhlury or nne /nd Iwlpr4s/nlnem ror kn°.Ini •Id.llwn OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO OAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Re1~r~nc~ d! ~ttichm~nta herd <br />EPA Form 3320-1 IRev 3 99) Previous editions maybe used Th1S i5 8 4-art COEttI. PAQE OF <br />