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FERMITTEE NAM VADDRESS (lmribe fwdit)!?ondLaeo,it 1 t/D(Qarent) <br />NAME <br />ADDRESS <br />MEEKER <br />FACILITY OL_OWYi3 <br />LOCATION "EKER <br />_LLY <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDE.SJ <br />DISCHARGE MONITORING REPORT (D RI <br />PERMIT NUMBER ascHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR M0 DAY <br />TO <br />FROM <br />Form Approved. <br />DIMS No. 2040-0004 <br />NOTE: Read inetructlo ne before complotmo thle form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. <br /> <br /> <br />EX FncouENCr <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE M <br />AXIMUM UNITS <br /> <br /> SAMPLE <br />I' r <br />F _ <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE ?ilU <br />- MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br />- SAMPLE <br />4-1 <br /> MEASUREMENT <br /> PERMIT <br />ill X <br /> <br />REQUIREMENT . <br /> SAMPLE <br />` MEASUREMENT <br /> <br /> <br />Vi='J <br />I PERMIT :sCli!• ;, . i <br />_ REQUIREMENT <br /> SAMPLE r' -- <br /> MEASUREMENT <br /> <br /> <br />i?G'_' Vfai- PERMIT <br />REQUIREMENT <br />:t b INST ll,:iX <br /> SAMPLE <br />V <br />n' f <br /> MEASUREMENT l? <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />1 nrttty r er Pena ty o Is. that thh doevment and aB altachenenb were <br />TELEPHONE <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER <br />l <br />DATE <br />prepared under my dlrecl <br />on or wisn Won In accordance with a system designee <br />t <br />if <br />l <br />I <br />f <br />l <br />i <br />y gather ¦nd evaluate IM <br />to care <br />hat qual <br />ied personne <br />proper <br />n <br />ormat <br />on <br />Based on m <br />In <br />uir <br />or the <br />erson or <br />er <br />b <br />lit <br />d <br />r <br />wh <br />na <br />th <br />t <br />q <br />y <br />p <br />p <br />.u <br />m <br />e <br />. <br />y <br />eo <br />se <br />o mo <br />te <br />e sys <br />em. <br />or those prnena dimity reoponoble for gathering the Inforwullow, the information <br />" ?i,V / J? f ?' t ? ,' j- K- submitted h, to the best of my knowledge and bellef, true. accurate. and complete <br />SIGNATURE OF PRINCWAL EXECUTIVE <br />l 1 <br />th <br />t th <br />re <br />ld <br />itti <br />I <br />i <br />nifi <br />nt <br />f <br />b <br />r <br />b <br />f <br />t <br /> am aware <br />en a <br />pena <br />or su <br />m <br />a <br />s <br />g <br />ca <br />es <br />ng <br />o <br />e <br />n <br />orma <br />ion, <br />TYPED OR PRINTED IndudiwX ibr poadblilty or fltle and Imp! sonment (or kno.int .1al.tletet OFFICER OR AUTHORIZED AGENT CODE MUL48ER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reforence 0attechmentsheroJ ^,4?R PRECIP EVENT BLS CLAIMED. IF' CLAIM APPROVED By WQCD- <br />EPA Form 3320-1 (Rev 3199) Previous editions may be used ?' This' IS 8 4-patt Rlnn. PAGE OF