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PERMr17EE NAME/ADDRESS ilnelude Fariliq Aamellnratiun if Different) <br />NAME <br />ADDRESS <br />EaJ ?i ? _ <br />-A G t7 <br />FACILITY HDR <br />LOCATION LA <br />+~ i? <br />I At-J,- F WAr,F. r-.TNF vIANAG <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 MO DAY <br />FROM TO <br />M I NUR <br />C SUBP MH ) <br />M - INTERIf-1 <br />E R&MINE; DROG TO CA <br />Form Approved. <br />OMB No. 2040.0004 <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 /> MEASUREMENT <br /> PERMIT s. _ . <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ?- r- -' <br /> REQUIREMENT r;V <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 - DA I <br /> SAMPLE <br /> MEASUREMENT <br /> <br />PERMIT .. . . <br /> REQUIREMENT ` <br />NAMEITITLE PRINCIPAL EXECUTIVE OFFICER 1 semif% under pemalq of law that Ihi dxument and all altachmanLs were TELEPHONE DATE <br /> prepared under mr dimction or sopersision in accordance with u system designed <br /> to assure that qualified Inersonnet prop•rl> gather and valuate ux information - <br /> submitted. Bused on not inquire of the pcrvm or perwrro who manage the system. , <br /> or those pers.ms diro tl% rrcprnsihle fur gathering the information, the information <br /> submitted is. In the hest of no, kno..ledge and holier, true, accuroote. and complete. <br />SIGNATURE OF PRINCIPAL EXECUTIVE - <br />- - I am aware that there are signifncant penaltim rur submitting raly information, AREA <br />TED -ibilin of nine and im <br />ri nnmeni ror knowing sioAathms <br />including the OFFICER OR AUTHORIZED AGENT NUMBER YEAR MO DAY <br />TYPED OR PRIN • <br />1 <br />p <br />COMMENTS AND txNLANA f IUfv Ur AIV T V IULA I IUIY.J (ttererence ati anacnrnents nerel <br />IR PRECIP FVEI'4T <br />EPA Form 3320.1 (Rev. 3M) Previous editions may be used This is a 4-part form.