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FERMITTEENAME/ADDRESS(marineF.,oiyN.a?L.,.,e tJDowswl) <br />NAME <br />ADDRESS <br />`31 STAT' <br />FACILITY <br />LOCATION 'LC1 WYO t <br />EKER O S 1 S? <br />NATIONAL ?OLLVTANT DISCHARGE ELIMINATION SYSTEM I/NPOES) Form Approved. <br />DISCHARGE MONITORING REPORT IDMR) OMS No 2040-0004 <br />PERMIT NUMBER DISCHARGE NUMBER ' <br />?- - FINAL fi!? <br />MONITORING PERIOD 'F+->Br---i? PONC ?GOC'L'• •=PGS F{ <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />NOTE: Read Imtructlorts before comoladna this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREGUENCr SAMPLE <br /> of <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> <br />REQUIREMENT > vit r ?t r 'tf <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <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 />NAME/TITLE PRINCIP L EXECUTIVE OFFICER T rertay -we, pen. 1y o h. that thle daument and .It atrachmenu were <br />TELEPHONE <br />DATE <br />- c prepared under m] direction or a+perMrton In accordance with ¦ system designed ? <br /> to swum that qualttld personnel properly gnaw and tealuale The Information <br />aubmtttd. Bard en my Inquiry of the person or pemoru who mansge the "stem J <br />/ / tf •. <br /> <br /> <br />- <br />- , <br />or thole persoro directly responsible for gathering the Information. Ow tnrormallon <br />(r <br />??•v (i ?.? .•. , <br />, i .i'j. ?:'L- submitted Is. To the bet or m] knowledge and beset. true, smunte. and comple <br />C t am..." that there acs dgdncim pendtks for aubmltung r?I.r Information SIGNATURE OF MIINCWAL EXECUTIVE <br />TYPED OR PRINTED , <br />Incloding the potdbtuty of fine and tmprleonment for knowing vWsUoeta OFFICER OR AUTHORIZED AGENT A A NUMBER <br />CODE YEAR MO DAY <br />L.NMMCrv 1.3- AMU enra.Ilnn „vie .+. n,e , e,v?r.,,vn.a (-1Wr Ir1UW W, I11.6Rr"ar"r7 rrI/I/ <br />APPROVED BY 40CD, <br />x l_L. ?1C? 1. r - i , . J .-. _ !? L i r 1 ... BURIDEN OF PROOF <br />1. 17- 1. b. r< I" ..T ;2 1il"It"L1ML: 1Nt) I KVlL, 11U.4,> <br />a02t0,7