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PERMITTEE NAME/ADDRESS!include F"Wty Aamr/i?carion if Diffierrttt) <br />NAME <br />ADDRESS <br />gs?x icy <br />'-,EN -J 81639 <br />FACILITY :,A M j P: COMPLEX <br />LOCATION ,EN --O 81635 <br />KARD, RECI__AMATrnN MANAQFR <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES) <br />DISCHARGE MONITORING REPORT (D R) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />FROM YEAR MO DAY TO YEAR MO D Y <br />1 <br />Form Approved. <br />OMB No. 040-& <br />MINOR <br />(SUBR <br />F - FINAL RUUI <br />DSCHG TO 'rRIB/GRASSY CREEK <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />U <br />L V <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 /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER I certif., under penalt% of law that this doeument and all attuchment\ were <br />d <br />di <br />ti <br />vi <br />d <br />i <br />i <br />d <br />i <br />h <br />d TELEPHONE DATE <br /> prepare <br />un <br />er my <br />rec <br />on or wper <br />s <br />on <br />n accor <br />ami, w <br />a system <br />esigned <br />t <br /> to aswrr that qualilled perwmnel properly gather and esduate The information 1 <br /> submiited. Based on my inquiry of the person or perums whip manage the systrm. J <br /> or those prrwns directly responsible for gathering the information, the information 1 j <br /> suhmilled h, to the beYt of ms knowledgr and beiirf, true. accurate. and complete. <br />I am ¦ware ih,a there are •ignifkant <br />en <br />dtie for uhn itting raise information <br />SIGNATU E OF PRINCIPAL EXECUTIVE ' <br />TYPED OR PRINTED p <br />. <br />, <br />including ihr 1-,ibilin of fine amt impri-nmenu far knowing violations. OFFI R OR AUTHORIZED AGENT AREA NUMBER <br />DE YEAR MO DAY <br />k,VMMCIV 10 AMW CArLANA I IVIq Ur AllT YIVLA I IVI`IJ Irfererence an arracnmenfs nerej <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. f-' I