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PERMITTEE NAMEIADDRESS (include fariUq Nan a"xion if ixfferrnrl <br />NAME - ; t <br />ADDRESS rJ? <br />_': 626 <br />LA <br />FACILITY HOR I ZI3N ; ! - <br />LOCATION -A e <br />LANCE WADE, ''i ? NE 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 M DAY <br />FROM TO <br />Form Approved. <br />OMB No. 2040-0004 <br />MINOR <br />(SUBR MH) <br />F -- F INAL N N"I'tRS <br />SR&MINE URNG TRI$ TO TUTTL_E DR <br />a/ <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO• <br />EX FREOUENCY <br />OF SAMPLE <br />TYPE <br /> AN <br />ALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE i i <br /> MEASUREMENT] <br /> PERMIT I }.<.:; <br />REPORT <br /> <br />t <br /> REQUIREMENT -?UDA AVC "-..Y MX f` o '- <br /> SAMPLE <br /> MEASUREMENTI <br /> PERMIT ;r ,: ?t S• a P r R <br /> REQUIREMENT ',)DA AVG CA I L.Y i <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ti „• a r -. ,- i4 ;t 7r r t t Cr- I <br /> REQUIREMENT :ioc'A r?V-*; DAII-•T" i1x <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT } REFURT - <br /> REQUIREMENT A?'V f)A I L_'( M X <br /> SAMPLE <br /> MEASUREMENT <br />• PERMIT <br /> REQUIREMENT _30DA AYG DAI!-Y MX <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT _ ?AILY MX <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT i " r s z r <br /> REQUIREMENT <br />NAME/T1TLE PRINCIPAL EXECUTIVE OFFICER 1 `o tik under penalty tdlaw that this dontment and all attachmenle were <br />direction tw su <br />r m <br />rnki,m in accordance with a svstrm desi <br />ned <br />re <br />ar <br />d <br />nd <br />TELEPHONE <br />DATE <br /> ? <br />p <br />g <br />p <br />p <br />e <br />u <br />e <br /> to assure that yuulificd personnel properls gather and ea aluate the information <br />- -- suhmitted. Bawd on my inyuin of the prrvm or prrw,ns who manage the cs stem. - <br /> or those persons diredJ) respon%iMe for gathering the information. the information - <br />- .uhmitt d i. to the hat of m% knowledge and belief. true. accurate, and complete- <br /> t there are si <br />nlfkvnt <br />enalties for submittin <br />fnlw Information <br />.w <br />e th <br />I SIGNATURE OF PRINCIPAL EXECUTIVE - - <br />TYPED OR PRIN D g <br />p <br />g <br />am <br />ar <br />a <br />, <br />including the possibility of fine and impri-rune•nt for km)%ing tiolwiort. OFFICER OR AUTHORIZED AGENT AROEA NUMBER YEAR MQ DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />v01 19 ,' "Thing k ?oitm. <br />EPA Form 3320-I (Rev. 3199) Previous editions may be used.