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PERMITTEE NAME/ADDRESS 11weYlsiaNHryJVanWLocetlon (/D(#Wvnr) <br />NAME <br />"i91ti?d? c' (?? <br />" i?s 1 i <br />f 1+11 <br />• <br />ADDRESS . <br />. <br /> C1.14 270 <br /> <br />FACILITY i"1.JNG'"*--; ,.<C-+'+4 VU-1 14 I1 I i'% <br />LOCATION _OMA A <br />{ i=. Vi J: y...4_.ER a JS I NL 3i? vlOR <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM //NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />Y Aft MO. D YEAR Ma-, D <br />FROM TO <br />Form Approved. <br />OMB No. 2040-0004 <br />NOTE: Read Instructions b4ftxe completing this form. <br />PARAMETER - QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. <br /> <br />EX FREOUENCY <br />OF SAMPLE <br /> ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE ::. s ... ,. . <br />V 1 kJAL- MEASUREMENT <br /> ( t^ a c.? t <br /> <br /> PERMIT <br />t;' ,Us l a _E r REnuIpEMEr,r' I NS r Mf! x <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />.......... . <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT -' <br /> REQUIREMENT <br /> SAMPLE t <br /> MEASUREMENT <br /> PERMIT <br /> REOUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> . PERMIT ? <br /> REQUIREMENT" 4 <br /> SAMPLE <br />.. MEASUREMENT <br /> PERMIT ; <br /> REQUIREMENT ` <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REGUIREMENT <br /> <br />NAME/T1TLE PRINCIPAL EXECUTIVE OFFICER I eertdy under penalty o law that this document and all attachments were <br />TELEPHON <br />E <br />DATE <br /> prepared under my direction or superv on In accordance with ¦ system designee <br />r to assure 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 /> <br />' <br /> <br />' <br /> or those persons directly responsible for gathering the Information, the Information <br />submitted Is <br />the best of m <br />knowled <br />e and b <br />t <br />li <br />f <br />t <br />t <br />d <br />l J <br />? ? <br />l'r <br />j <br /> <br />, <br />y <br />g <br />o <br />e <br />e <br />, <br />rue, accura <br />e, an <br />comp <br />ete. <br />I am aware that there'sm significant penalties for submitting raise information <br />ONATURE OF PRINCIPAL EXECUTIVE ! ? <br />rJ <br />g <br />? <br /> , <br />I <br />l <br />di <br />h <br />ibili <br />f fi <br />d I <br />i AREAI <br />SPED OR PRINTED nc <br />u <br />ng t <br />ne an <br />e poss <br />ty o <br />mpr <br />sonment rot knowing vloIs0ons. OFFICER OR AUTHORIZED AGENT ODE <br />C NUMBER YEAR MO DAY <br />COMMENTS AND EXPL.ANAI IUN Vr ART VIVI.A I IVNS IRsrarence ail arracnmenrs q% al <br />It'?_ 3?'E,", <br />??'tJ.3=??°3: r?"3i t.?C;St'?(--?£ ?. C. 'y ! cY.. r s''Y r?:'?€:4r i r";k'fli? tICla?9"'!''i A?°O. vita! ILPOR <br />„9 °'i' CIG= e' ;a °irlr2'd' "? 3113/Y IN"?. 01!_ & i,IRE>' SE GK: - k . r: 1. C. <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. by / (A W_-??rt'I{ m. PAGE sOF <br />c„i . r'it i'' i ,_ - .. - - .. 111101111__ , <br />•.:.. .. 4 Wis. Iw?19ANtf aawtMtan'?1MibW saww.r• ' - .. -. .. y .I ,. .. _ i% P. . le