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PERMITTEE NAME/ADDRESS (Include Farwtf NanteQ.xutiun ijl)iffrrrnt) <br />NAME - <br />ADDRESS <br />FACILITY <br />LOCATION t b <br />4C <br /> <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES) <br />DISCHARGE MONITORING REPORT (D R) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved. <br />OMB No. 21340.OW4 <br />M 1.'? <br />( .`r-' Ll : !! <br />F - FI14AL I'lf'4 FIRS <br />SFi&MINE: DRNf TRIS TO TUTTLE DR <br />NOTE: Read Instructions before comoletina this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION N0. FREQUENCY SAMPLE <br /> <br />of TYPE <br /> EX ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT r: <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 <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 />NAMEfnTLE PRINCIPAL EXECUTIVE OFFICER I certify under penally d law that this document and all attachments were <br />d <br />i <br />d <br />di <br />i <br />i TELEPHONE DATE <br /> prepare <br />un <br />er my <br />rc<t <br />olt or super <br />s <br />on in accordance with a so seem dnignad <br /> too assure that qualified pervmnel prnperh gather and evaluate the Inhumation - <br />- - - submitted. Rased on my inyuirs of the perwm or Parsons who manage the svstem. • _ i <br /> or tho- prrslm, directty responsible for gathering the information, the information - - <br /> <br />- submitted is, to the best of mi knowledge and belief. true, accurate, and complete. <br />I am aware that there are si <br />nificant <br />enalties for submittin <br />i <br />f <br />ls <br />f <br />m <br />tio <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />TYPED OR PRINTED <br />. g <br />p <br />g <br />a <br />e <br />n <br />or <br />a <br />n. <br />indudmi! the possibilih of nne and imprhunment for knowing violations. OFFICER OR AUTHORIZED AGENT <br />] AREA NUMBER <br />CODE YEAR MO DAY <br />f ICf CI <br />EPA Form 3320.1 (Rev. 3/99) Previous editions may be used. -%' %-} 1 ? This is a-4-part Form.