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PERMITTEE NAME/ADDRESS tlnclade FacifitY SonelL ration ijDiffirent) <br />NAME `t <br />ADDRESS k '; I"! <br />BOX `529 <br />A '. Q 51424 <br />FACILITY I- OR I ZI13 d M i [-'.E <br />LOCATION (i C n 5142q <br />APAY- = I Ir.rc .? T F.Ir' rnAhtorsC0 <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 />Form Approved <br />OMB No. 2040-0004 <br />MINOR <br />( ?UBR MH) <br />F - FINAL MNTRI <br />SFt•_v.MINE TRNG TR [II TO T'%TTLE DH <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY <br />OF SAMPLE <br /> <br />EX <br />IS TYPE <br /> ANALYS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />. MEASUREMENT1 <br /> PERMIT <br /> REQUIREMENT IVG =' } i <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT T <br /> REQUIREMENT _ <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT fi c t c ;_. <br />- <br /> <br />REQUIREMENT <br />DCD.- <br />DAIIL_'v - <br /> SAMPLE <br />_;, MEASUREMENT <br /> PERMIT _ a ; c u <br /> REQUIREMENT Dr = 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 />NAMEJTITLE PRINCIPAL EXECUTIVE OFFICER I certif% under Je Udlc of la% that thi, d-ninent and all attachments were <br />TELEPHONE <br />DATE <br /> pnpar •d under m, direction or supra won in amtrdwnre with u :tstero designed <br /> Its w-re that qualified prrstnnel prnprrl? gather and rsaluate the infortnaliun <br /> .ubmitt d. Hand on m% inyuir) of the pervm or penons who manage the %%%tem. <br /> or thox prrvms directly reslamsible for gathering the information, the information <br /> submitted is. to the beat of mi knowledge and betwl', true. uerurate. and compkte. SIGNATURE OF PRINCIPAL EXECUTIVE <br /> I am wwure that there are significant penalties for submiuing raisr infornm6un. <br />i <br />Wti <br />i <br />OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br />TYPED OR PRINTED a <br />ns. <br />including the foo-ihilih ar fine and imprisonment for know <br />ng s OD <br />%+UMMtIV 1 J AMU r-ArLMIYA I IUIV Vr MVA T <br /> <br />EPA Form 3320-1 (Rev. 3'99) Previous editions may be used. 0004C This -is. a"4-pail fo nl.