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PERMITTEE NAME/ADDRESS (7-AkFrWryNa.-tLr .u°nVD(ff ,,,,) NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM //NPDESI <br />NAME DISCHARGE MONITORING REPORT (DMR/ <br />ADDRESS ' <br />b U I- 14.1 PERMIT NUMBER DISCHARGE NUMBER <br />FACILITY <br />?pDy MONITORING PERIOD <br />5 I U y G tt i . u `, t n .. •. YEAR MO DAY YEAR MO DAY <br />LoG?T1oN ? A L T S P. Ut CC r_ FROM TO <br />? ?trG L. KICi:Er._ Y.r' <br />Form Approved <br />OMB No 2040-0004 <br /> <br />1C COAL LEth? <br />- but <br /> <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREOpUENCY SAMPLE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE <br /> SAMPLE <br /> MEASUREMENT <br /> PER <br /> MIT <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br />_ PERMIT h L 1/ i1 <br />h <br /> REQUIREMENT <br />C:CN <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT L PC FF I C L/ <br /> REQUIREMENT A I L Y P X <br /> SAMPLE ' <br /> MEASUREMENT <br /> PE <br />MI <br /> R <br />T <br /> REQUIREMENT <br />U li A 1' h i C <br /> SAMPLE <br /> MEASUREMENT <br /> PE <br />I <br /> RM <br />T - <br />, ' a - <br />` 1 t• <br />.: , L <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> r C <br />r <br />Y REQUIREMENT <br />. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> _, ;y r <br />FL` Vi <br /> <br />REQUIREMENT . - <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER ' an" y " of penalty ° L. that <br />this document and sit attachmenU were <br />PrePamd under my direction or wp, m on In aecordsnee with a System desi <br />nee <br />- <br />TELEPHONE <br /> <br />DATE <br /> g <br />to <br />s <br />re th <br />t <br />lifi <br /> a <br />m <br />a <br />qua <br />ed Personnel properly gather and evaluate the information <br />itt <br />b <br />f <br />B <br /> w <br />m <br />et <br />. <br />ased on my Inqulry -(the Person a persons who manage the syst,m, <br />or these <br />erv <br />r <br />di <br />tl <br />r <br />ibi <br />f <br /> y <br />P <br />e <br />ts <br />rec <br />espons <br />r <br />or gathering the Information, the Information <br />submitted is <br />th <br />t <br />b <br />t <br />kn <br />l <br />r <br />d , <br /> . <br />o <br />e <br />ra <br />my <br />ow <br />o <br />e <br />ge and beBef, trve, accurate. and complete. <br />I am swam that then: am signifkant Penalties for <br />b <br />iln <br />r <br />i <br />f <br />I <br />SIGN ; ?. <br /> <br />TYPED OR PRINTED w <br />m <br />ng <br />a <br />se <br />ormed". <br />n <br />Including the possibility of flee and Imprisonment for lnowlng riolatJorm ATURE OF PRINCIPAL EXECUTIVE <br />OFFICER OR AUTHORIZED AGENT <br />AREA NUMEIER <br />Y <br /> <br />nnaaaaC?,rC a?tn CYDI aNATIAN (1F ANY Vint <br />•TIr%LJC res_i_-____ <br />CODE EAR MO DAY <br />.SUN;; PfhC7Ij? :V?111 (. :i_` EC_ <br />EPA Form 3320-1 (Rev 3/99) Previous editions may be used. This is a 4-part form PAGE OF