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PERMITTEE NAME/ADDRESS (lnelude Facilin•.famed anion if Different) NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES) <br />NAME DISCHARGE MONITORING REPORT (D R) <br />ADDRESS <br />bLIX PERMIT NUMBER DISCHARGE NUMBER <br />I A <br />FACILITY I {C=: .. MONITORING PERIOD <br />LOCATION FROM YEAR MO DAY TO YEAR MO DAY <br />i pl t.U <br />rLANCE WADE, MIML MAW-:-. <br />Form Approved. <br />OMB No. 2040.0004 <br /> <br />PW-TRS <br />K <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 .. , <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT r <br /> REQUIREMENT 1 ' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT i <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT -.. Lr - <br /> REQUIREMENT l' <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 certify under penalty of law that this da ument and ail attachment% were TELEPHONE DATE <br /> prepared under my direction or sttpenisiun in accordance with u system designed <br /> to assure that qualified Penonnel proprriy Rather and rs aluate the information --? <br />-- submitted. Based on my inyuin of the pe-m or p-ae, who manage the.ystrtn, <br /> or tho Person directly mitomsible for gathering the information, the information , <br /> submitted is. to the best of my knowledge and belief. true, a rueate, and complela SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED OR PRINTED I am awarr that there are significant Penalties for submitting false infurmabnn. <br />including the possibility of raw and impriwnmrut for knowing.i+,l:niom. <br />OFFICER OR AUTHORIZED AGENT AREA <br />ODE NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />. i T APPLIED FOR IOYR/24HR PREC IP EVENT - SEE I A.2, <br />dS - I. C- 10) PG 20. 30 DAY AVG IS HIGHEST MONTHLY <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. This is- a 4-part foml.