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PERMITTEE NAME/ADDRESS (include faeili¢:\'omdlaratian ipiffrrenri <br />NAME u -'-"0 <br />ADDRESS i <br />FACILITY 2 I : I'd i • +.: <br />LOCATION <br />LMC:E WADE. MT NF MART <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES) <br />DISCHARGE MONITORING REPORT (D R) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />31' FROM YEAR M DAY TO YEAR MO DAY <br />ER <br />Form Approved. <br />OMB No. 2040-0004 <br />NOR <br />JBR MH ) <br />- FINAL <br />KeMTNF 7RNn Tn TiJ`f TI F DRAW <br />NOTE: Read Instrurtinns hefnrP rnm(iiatino this form. <br /> <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY SAMPLE <br /> <br />E OF <br />TYPE <br /> X ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT , ifa -rR '1A Y. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT r i r... <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT ii MFr <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 crrlYs under penally of law that thb documant and all attachments were <br /> <br />d <br />d <br />di <br />ti <br />6i <br />TELEPHONE <br />DATE <br /> prepare <br />un <br />er my <br />rrc <br />un or super <br /><w in accordance with a %vyem almignsd <br /> 1. assurr that glmliftad perconnef properly gather and esaluate the information <br /> submitted. Hased on my inquiry of the person or perxms aMo manage the sustrm. ` <br />• - or Its- persiau directi) respmsible for gathering the informutim. the information .i <br />1 r . - <br />i l- <br />- ,? submitted is, to the bc%t of m> knowledut and Wief. true, navurule. and complete. - i • <br />. <br />- <br />l I <br />? <br />- 1 am aware that them arc significant penalties ror submitting fatw information SIGNATURE OF PRINCIPAL EXECUTIVE , <br />-- <br />•• <br />- > j <br />- <br />TYPED OR PRINTED <br />- -- - - - - - -- - , <br />including the pussibilily of fine and imprisonment for knowing violations. <br />-- - - OFFICER OR AUTHORIZED AGENT AREA NUMBER <br />CODE YEAR MO DAY <br />UUlvlmO14 I J A114v r-Ari-1At141a 11U11 Ur 1+114 T vlUL.w I I1.0114A (rreference ail arfacnmenfs nere) <br />EPA Form 3320.1 (Rev. 3199) Previous editions may be Used. %`_ 551' n{ g-14 a'4-part fOrTn.