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PERMITTEE NAMEIADDRESS 1Inchide FaciWy Name l iranan if Differrnq <br />NAME L L+ <br />ADDRESS ''- <br />LA ?Q 81424 <br />FACILITY HOR 1 ;':_:N' P' [ I <br />LOCATION I -A D 82424 <br />I AN(. P WAr) I odF ?-IANAGER . <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (,WDES) <br />DISCHARGE MONITORING REPORT (Di R) <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 />MINOR <br />(SUPR <br />M - INTERIN 2`IN tR; <br />5I &MINE DRNG TO CALAMITY DRAW <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />+'r MEASUREMENT <br /> PERMIT , i 1, -4 :. C f <br /> REQUIREMENT M.4 let ONT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT _' i ast t it s <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT t Q#is x 7#77it t?-t <br /> REQUIREMENT ' <br /> SAMPLE <br /> MEASUREMENT <br />r. PERMIT 2. it 1: _ <br /> REQUIREMENT {- <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT I r: z. t7 <br /> REQUIREMENT %Cx ?1Ft T R i• AX <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - -r . .. <br /> REQUIREMENT 3; : T' =: •; {r OR i"i' MA., <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - - ; 7 ?, rt <br /> REQUIREMENT <br />NAMElf ITLE PRINCIPAL EXECUTIVE OFFICER I ccrtif) under prnuh> of law that this tl,arurttrnt and an attachments *ere TELEPHONE DATE <br /> prepured under tn) direction or wiienision in asrordance with a ,vetrm designed <br /> to as?urr that qualified perxmnel properly gather and esaluale the Information -- - - - " <br />- <br /> submitted. Bard on my imruirs of the perwn or perwm w W, manage the svctem. ?l <br /> or those pe",ns directly rnpnnsihle for gathering the information. the information -- - <br /> accurate <br />and complete <br />submitted is <br />to the hest of ms knowled <br />e and helier <br />true t f <br />r . <br />. <br />g <br />• <br />, <br />. SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED OR PRINTED I am aware that there are Oenifimnl penalties for submitting false information <br />including the possibility of file and imprimmment for knowing slalatiom. <br />OFFICER OR AUTHORIZED AGENT AREA <br /> <br /> <br />E NUMBER <br />COD <br /> <br /> <br />EAR <br /> <br /> <br />O <br /> <br /> <br />AY <br />COMMLNIb ANU LAVLANAIIVn Vr ANT VIVLA I IVIY.1. (r7ereruflut' dry d11dGf1r1rewlai 11crul <br />ED FOR IOYR, 24HR PREC IP EVENT - SEE I . A. <br />10, PG 20. 30 DAY AVG IS H I GHES•r MONT}il <br />This. is -a '•?-part' form. <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. PAGE OF