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PERMITTEE NAME!ADDRESS clnrlude Faaltrv Name4noorion tFDig mr) <br />NAME <br />ADDRESS T?( <br />'t <br />FACILITY <br />LOCATION <br />CID 81648 <br />MANAGER <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved. <br />OMB No. 2040.0004 <br />X <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />({ MEASUREMENT <br /> PERMIT is r I TRL Y" Ftf <br />- REQUIREMENT <br /> SAMPLE <br />L; . A'::. MEASUREMENT <br /> PERMIT <br />r L ); ,,)..?. -' ;D 55 `JAL 1i. REQUIREMENT - <br />_ SAMPLE <br />L":'- MEASUREMENT <br /> PERMIT `K AD <br />)= L,i li.."1 ?fY 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 PRINCIPAL EXECUTIVE OFFICER I LCrufy under penalty M law that this document and all attachments were <br />- <br />h <br />d TELEPHONE DATE <br /> tsion in accordance wit <br />a "oem <br />prcparcd under my direction or super <br />esigned <br /> to assure that qualified personnel properly gather and evaluate the information <br /> .subauried. Based on my inquiry of the person or persons who manage the system. <br /> or those persons directly responsible for gathering the information, the information <br /> submitted is. to the best of my knowledge and belief. true, accurate, and complete. <br />are that there are si <br />false information <br />I a <br />nificant <br />enalties f <br />r submittin <br />a SIGNATURE OF PRINCIPAL EXECUTIVE L. <br /> <br />TYP OR PRINTED w <br />g <br />p <br />o <br />g <br />. <br />m <br />ossibility of fine and un <br />risonnict:t fm kn-in <br />including th <br />siolation` OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br /> e p <br />p <br />g CODE <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />EPA Form 3320-1 (Rev. 3199) Previous eddiors may be used. .JQO3c • Thii IS a 4-part ('oml.