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PERMITTEE NAMEIADDRESS ilnelude Fariliry.?'wRt/hxarian if ixf io,w, NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES) <br />NAME DISCHARGE MONITORING REPORT (D R) <br />ADDRESS x <br />??}( PERMIT NUMBER DISCHARGE NUMBER <br />424 MONITORING PERIOD <br />FACILITY ; 10R 17 ON M 11`4 <br />LOCATION YEAR MO DAY YEAR MO DAY <br />LA i D 81 FROM TO <br />I AN(- .F WAnF, M T NF MANAGtF R <br />Form Approved. <br />OMB No. 2040.0004 <br />MINOR <br />(5UBR MH) <br />F - FINAL MNTK5 <br />SI &MTN-F ,,PNG TR 15 TO T. T ii. ` DR <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO- FREOUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE - <br /> MEASUREMENTj <br /> PERMIT _,? <br />EPORT <br /> <br />' <br /> REQUIREMENT ;'1`1 AVG DAILY MX r 0N <br />T; <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT , EP DR T <br />;l <br />LUti i REQUIREMENT J1)A AVG DAILY M" <br /> SAMPLE <br />.-I! t t" ' MEASUREMENT <br /> <br />PERMIT t _t:ttil <br /> REQUIREMENT AVG E' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT f <br /> REQUIREMENT i)I'iA A'Ji: DAILY f1 ;K <br /> SAMPLE <br />:- i s QLt,`L . MEASUREMENT <br /> PERMIT _ n rtkiE :i _ c y c <br /> REQUIREMENT ?30DA AVG DAILY MX <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT N I LY t'. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT a I <br /> REQUIREMENT _30DA <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER Icrrtift underpenult) afluw that third«vnxnt.ndanruuchment.+»ere TELEPHONE DATE <br /> prepared under m% direction or wpenision in acYordaacr with a system de.it;ned <br />\ ` <br />_ to assure that qualified peminnel proprrly gather and esuluate the information '•, <br />- --_ <br /> ,uhmitted. Rasad on in, Inquire of the per n or persons who manage the ystcm, .? , /1 <br /> or thine persons directly responsible for gatt"ng the infor nation. the Information ' _ <br /> <br />wbmit" i• <br />to the bca of ml knowlydge and bellef <br />true <br />accurate <br />and complete <br />sA ' <br /> <br />?t - . <br />. <br />, <br />, <br />. <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />TYPED OR PRINTED I am aware thin there are significant penalties for whmilting false information. <br />including the Ixwsihilil-f fine and imprisonment for knowing riolations. OFFICER OR AUTHORIZED AGENT A <br /> <br />REA NUMBER <br />CODE <br /> <br />YEAR <br /> <br />MO <br /> <br />DAY <br />G0MMtNT5 AND tAPLANAIIUN UI- ANY VIULAIIUNJ (rtererence an arracnmenrs nere/ <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. 00153 / f?%n'itR. 4L 1:3>ft' 1'cwm.