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PERMITTEE NAME/ADDRESSp,..6&FordtyNmmVLeeartew4/D(Obwu) <br />NAME <br />ADDRESS <br />tii3X 1 i ..4 <br />IA Co <br />FACILITY - NO. 3 Pl I NE <br />LOCATION RSET GO <br />7=t = r, r: AD DD=CT TIT-NIT <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM /INPDESI <br />DISCHARGE MONITORING REPORT (DMRI <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />? <br />l (/ <br />l Form Approved <br />` ? <br />rt I Ntl . ?? ? ; OMB No. 2040 0004 <br />( SUBR h'iH ) <br />F - FINAL <br />itINE -L)RAINAOE 'TO N i=(` :;,-NTSr?N <br /> <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 />$ S <br />i <br /> PERMIT <br /> REQUIREMENT T <br /> <br /> SAMPLE <br /> MEASUREMENT O <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE I) I1D <br /> MEASUREMENT <br /> <br /> PERMIT sr <br /> REQUIREMENT s <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ` <br /> REQUIREMENT <br /> SAMPLE ?00 SeY 0694001 <br /> MEASUREMENT ?_`_ _--- 1 <br />--? <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />a} <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />PRINCIPAL EXECUTIVE OFFICER t rert"y ° er pen. ty o now thus thh documem and ¦11 allochments wen TELEPHONE DATE <br />NAME/T nE <br />prepared under my dlrrctlon or superclslon In .ccord.nre with a system designed <br />to amen that qualified personnel properly gather and evaluate the Information <br />submitted. Based on my Inquiry of the person or Persons who manage the system <br />or those per"ns directly respwdble for gathering the information. the information <br />submitted Is, to the best of my knowledge and belle. true, accurate, and complete. <br />IGNATURE OF PRINCIPAL EXECUTIVE <br /> 1 am swan that there an signlfinnt penalties for submitting rate Infornrtion, S AREA <br />U <br />E <br />Y <br />TYPED OR PRINTED ImIluding the possibility or fine and imprisonment for knowing 0oletlom OFFICER OR AUTHORIZED AGENT MB <br />R <br />CODE N YEAR MO DA <br />COMMENTS AND EXPLANATION yr AtvT VIVLA i 1vnJ fneroronc, •a irttccnmtrnta n.r.r <br />Rr? 1F TS HIGHEST MONTH'..Y AVERAGE DURING PERIOD REPORTED. <br />This is a 4-part form PAGE OF <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used