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PERMITTEE NAME/ADDRESS (7neYdr ltetNryNs. Laeanw yD(?trwv) <br />NAME <br />ADDRESS <br />FKER C7 8 <br />FACILITY ?:..E)Wyo 11, <br />LOCATION "K ER ! 8 <br />'-LL.Y G' _iANDERS, nR <br />NATIONAL POLLUTANT DISCHMOE ELIMINATION SYSTEM /rNPOES/ <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHAME NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DA <br />FROM TO <br />Form Approved <br />MINOR OMS No 2040-0004 <br />(s'%; " <br />F - F I NAL Mt'- <br />WASH DAY TO WORK AREA POND <br />NOTE: Reed Irntrucdora before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. <br /> <br />EX FREOVENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />L /100 <br />?J <br /> MEASUREMENT <br /> <br /> PERMIT <br />REQUIREMENT <br />:300A A G <br />DA II-Y M <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 /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />NAMEIrfTLE PRINCIPAL EXECUTIVE OFFICER I t•ertty ¦ ndf pens Iy o law 6%h Ihal u dotvmrnt and oN attaclamatts were ? TELEPHONE <br />prepared stder my direction or superH/on In atrordamr with • system designed DATE <br />17T to assure that q,.aMed per,onnel properly gather and ...Ia.te the lnrar,n.Ilon <br />/? <br />sabmitted. s=td on my inquiry or the periam or per,ons who m.ttage the system, <br />-?? • (' <br />or those persons dlrectty responsible he gathering the lnforrnatloo. the Inform.llnn _ <br /> <br />• <br />( / ? (H Kir_ tL- submitted h, to the best or my ?nawtedgo and beYer. true. amarate, and complete. <br />SIGNATURE Of PRINCWAL EXECUTWE <br />i <br />ft <br />i L ' -' .' <br /> I am .w.n Choi there on s <br />gN <br />e"I penaMW for submitting ralw Inrormatlon, AREA <br />TYPED OR PRINTED lm•ludlng the possibility or fine and Imprisonment for knowlog lolatimm OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reforencea#attachments hotel <br />4NR PRECT_P EVENT IS CLAIMED. IF CLAIM APPROVED BY WQCD, <br />ASUREMEN ' _ ? I. A. 2, <br />EPA Form 3320-1 (Rev 3;99) Previous editions may be used rJ ??''' This is a 4-part form. PAGE OF