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PERMITTEE NAMEiADDRESS e1ncda4 FacWt)' hbme 1 yarn ijDiiffmar) <br />NAME <br />ADDRESS. <br />FACILITY { <br />LOCATION fj 81641 <br />I API-), k 1 NF :IANAC-?F.R <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (OMR) <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 />SDH3/5 SEDI POND TO RED WA` <br />• x <br />NOTE: Read Instructions before completing this form. <br />It-AN <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY <br />OF SAMPLE <br /> TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />n F?; f MEASUREMENT <br /> PERMIT <br />_ ?. REQUIREMENT <br /> SAMPLE ' <br />TF-; MEASUREMENT <br /> PERMIT # tt t it'.r 't s'C '; ? ' -f (3F? 'T <br /> REQUIREMENT , A?'-• L <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> <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 j <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I .citify under penalty of law that this document and all attachments mcre TELEPHONE DATE <br /> prepared under my direction or supervision to accordance with a system destgrod <br />y <br />Se U,/ if !? . r ' .0-_r? to assure that qualified personnel properly gather and evaluate the information <br />uiry of the person or <br />ersons who manage the system <br />Rased on m <br />in <br />submitted 1 <br />- <br /> , <br />y <br />q <br />p <br />. <br />or those persons dinetly responsihlc for gathenng the int"ormaoun. the information 01 <br />- - -? <br />? <br />wled <br />e and hrlief <br />true <br />auvrnte <br />lete <br />to the best of m <br />Lr <br />and com <br />b <br />i <br />t <br />d i _ _ <br /> e <br />y <br />o <br />g <br />, <br />, <br />, <br />p <br />su <br />m <br />t <br />s, <br />if <br />f <br />f <br />l <br />i <br />f <br />ti <br />h <br />i <br />l <br />i <br />b <br />i SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />E ere arc s <br />icant pena <br />es <br />or su <br />m <br />tting <br />a <br />se <br />n <br />orma <br />on. <br />I am aware that t <br />gn <br />t <br />ti <br />h <br />b <br />f <br />i <br />d i <br />i <br />f <br />k <br />i <br />.i <br />d <br />l <br />d <br />l OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br />TYPED PRINT <br />D sonmcrtl <br />now <br />o <br />a <br />ons. <br />e possi <br />ity o <br />t <br />ne an <br />mpr <br />or <br />ng <br />inc <br />u <br />ing t <br />i CODE <br />GUMMENTS AND EXPLANATION OF ANY VIOLAI?UNb (Kererence an arracnments mere/ <br />Th1 <br />EPA Form 3320-1 (Rev. 3199) Previous ediftons may be used. O?`• g 4-part tt1rn1•