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PERMITTEE NAME/ADDRESS rlncfade Facifiry.Vame/location ilfhffmentt NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS <br />PERMIT NUMBER DISCHARGE NUMBER <br />FACILITY 1'I I N E C OM P L„ CC I S MONITORING PERIOD <br />•.h X' YEAR MO DAY YEAR MO DAY <br />LOCATION 7) F-N CC) 131'. FROM TO <br />KARn, RFrI AMATTIIN MANAGh <br />Form Approved y <br />OMB No. a04O-Wb4 ) <br />MIN <br />(SU <br />F - <br />OSC <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />) <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT - <br /> <br /> SAMPLE r 1 J <br /> ME <br />SUREMENT i i <br /> A _ <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 />1 <br />F <br /> REQUIREMENT <br />NAMEITITLE PRINCIPAL EXECUTIVE OFFICER I c rtifi under pent of law that mis d-ument and all attachments were <br />with <br />d <br />d <br />di <br />i <br />i <br />i <br />d <br />t <br />d <br />i <br />d TELEPHONE DATE <br /> on or supers <br />Pmpara <br />un <br />er ms <br />ml <br />sion <br />n accor <br />ance <br />a sys <br />em <br />es <br />gne <br /> to assure that yuaiined per nmi properl. gather and esaiuate the information <br /> submitted. Haw d on my inyuin or the pe-ffi or;crams who manage the,*.tem. , - <br />- <br /> or those persons direruy responsible for gathering the information, the information j <br /> submitted is, b- the twrt..f my knowledge and ladle!, true, accurate. and complete- <br /> <br />h <br />b <br />ti <br />I <br />h <br />d'k <br />t <br />l <br />i <br />6 <br />* <br />itti <br />f <br />l <br />i <br />f <br />I <br />OF PRINCIPAL EXECUTIVE <br />i <br />' <br /> <br />TYPED OR PRINTED e 1, are stgn <br />n <br />orma <br />on. <br />am aware t <br />m t <br />3m <br />Pena <br />t <br />es <br />vt <br />m <br />ng <br />a <br />se <br />n <br />imludink m, p .•Ihihn of nine and imprisonment for knowing siolations. <br />FFICER OR AUTHORIZED AGENT AREA <br />D NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VwLA I IUNS (mererence an arracnmenrs nerej <br />_'aT A REASONABLE POTENTIAL ANALYSIS DE <br />EPA Form 3320-I (Rev. 3/99) Previous editions may be used- 000216 it. a 4-part f6mi.