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PERMITTEE NAMEIADDRESS(7w hokFotrbtyNar?Lorattoo4fD(i.ar) <br />NAME <br />ADDRESS -, _ <br />- s1 ST <br />FACILITY ,-KKR <br />Iwyo <br />LOCATION _ KEN <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES) <br />DISCHARGE MONITORING REPORT IDMR) <br />PERMIT NUMBER DISCHARGE NUMBER_ <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />t? <br />Form Approved <br />OMB No 2040-0004 <br />NOTE: Read Inetructlons bofoh completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, AlEOUENCY <br />OF SAMPLE <br /> EX TYPE <br /> >< ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> <br />SAMPLE J- <br />. <br />" MEASUREMENT <br /> PERMIT <: , >. r. ;..F.. <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 PRINSIIPAL EXECUTIVE OFFICER I eerttif under pens q o ow that lhh document and all attachments were TELEPHONE <br />prepared under my dimcilon or mprr•hlon In acrmdanm with • %yelern designed DATE <br /> <br />Property <br />gather and <br />te The Inftww <br />/:. _ J f-,, L [y ! to asat that aua personnel <br />mana <br />e th <br />I <br />l <br />dth <br />+ <br />r <br />w <br />wh <br />tem <br />B <br />d <br />pi <br />eis <br />W, on me <br />bmlti ed. <br />g <br />nau <br />rT <br />e persa <br />or pe <br />s <br />u <br />e sys <br />. <br />re <br />o <br />r <br />otdbkt for <br />atherin <br />the Informallow <br />the Information i <br />; :? J t 1 <br />? t % <br />th <br />sl <br />d1 <br />? <br />r! <br />r mp <br />g <br />g <br />• <br />. <br />, <br />or <br />mc <br />ose pemom <br />(/` ) ,?r.'? ?• l)L subwJlted In. to the best or my knowledge and belief, Intl, a r tr, and eotnpkle. !V 1 ` ( i r <br />NATURE Of FRINCI?AL EXE <br />I . <br />_ <br />. <br /> 1 am aware that there are dgnlRcant penalilm for submllnng fal+e Infornution. S <br />G A A <br />ER MO <br />TYPED OR PRINTED Ineluding the poatbnlry or fine and ImprNonmrnt for knowing Hdatlorn. OFFICER OR AUTHORIZED AGENT CODE NUMB YEAR DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference sd attachments hers) <br />This is a'4-part farm PAGE OF <br />EPA Form 3320-1 (Rev 3!991 Previous editions maybe used