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PERMITTEE NAME/ADDRESS Ilarfudr Faci6n• .1'am4,,.afinn if th;(frrrnff <br />NAME <br />ADDRESS _ <br />'.NIA CD 81428 <br />FACILITY <br />LOCATION ;NIA 70 8142S <br />ADLEY '- HAN=' '.IICF.. PRES. <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />FROM YEAR MO DAY TO YEAR MO DAY <br />Form Approved. <br />OMB No. 2040.0004 <br />MINOR <br />(SUBR MH.) <br />F - FINAL <br />hIW TO UNNMD TRIB/H1 <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO• FREOUENCY SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT "' t' ` 7 `- <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />} .? <br />,. <br /> <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER I certift under Penalq or law that thh dowvmenl and all attachment, were <br />ed under m <br />tio <br />er,isigm i <br /><u <br />st <br />dire <br />or <br />d <br />c with <br />s <br />d <br />i <br />d <br />TELEPHONE <br />DINE <br /> y <br />prepar <br />c <br />n <br />wp <br />n " <br />r <br />anc <br />a <br />y <br />em <br />m <br />gne <br /> to M.W" that quatifhd Personnel properly gather and r. aluate the information <br /> submitted. Ramd on my inquire of the pe-m or pemm, who tonnage the ,y,letn. 1 <br /> or tho- prmims directh rrspmsiIA- for gathering the information. the information - - <br /> <br />- smhmitted is, to the hest of my kni-ledge and belief. true, "curate. and complete. <br />i <br />I <br />th <br />t th <br />i <br />ir <br />t <br />l <br />f <br />b <br />it <br />i <br />r <br />te <br />i <br />f <br />i SIGNATURE OF PRINCIPAL EXECUTIVE <br /> pena <br />ant ..are <br />a <br />ere are s <br />gn <br />isan <br />t <br />e <br />or su <br />m <br />t <br />ng <br />a <br />r <br />n <br />ormat <br />on. OFFICER OR AUTHORIZED AGENT AREA <br />TYPED OR PRINTED including the Possibility of rim- and impri-nmrnt ror knowing siohitions. D NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. TINS is a 4-part form.