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PERMITTEE NAME/ADDRESS(7-ho*Fr4bryNo-WLG .ti-(fD(O..wo) <br />NAME <br />ADORESS <br />FACILITY OI': 'r <br />LOCATION -KLI< <br />NATIONAL POLLUTANT 04SCHAAGE ELIMINATION SYSTEA/ fNPDES) <br />DISCHARGE MONITORING REPORT fDMRI <br />PERMIT NUMBER DISCHMGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved. <br />oM8 No 2040 0004 <br />RECEIVED <br />OCT 2 3 2008 <br />Division of ReC13MAOn, <br />Mining and Safety <br />NOTE: Read Ifwtructlorw before complet" the form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREOUENCY <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 <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />T <br /> MEASUREMEN <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 t -ruty • p .. fly ° la. that thh document and all atl.chmants .ere TELEPHONE DATE <br />prepared order my dlr-Iton or wpl. -1 cm In wrocd.nce -fill . system dealgned <br />to more that qu.lfled personnel properly gather and evaluate the Information <br />wbmatt.d. laved on my Inqulry of the person or persdu who mange ch. system, <br />or that pervom dlreclly -,tporelbtr for gathering the Information, the Informatlon <br />wbmilted K to the hest of my kno.ledge and better, [me. ar,-mle, and complete. <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br /> I .m.... that then. ¦m algrrlk.nt pens le. for aabmltting rate Information. AREA <br />TYPED OR PRINTED Incfudint the ponalblflty of me and Imprisonment for knowing Aolwtl ns OFFICER OR AUTHORIZED AGENT CODE HUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference sff attachments here) <br />EPA Form 3320-1 (Rev 3199) Previous editions may be used This is a 4-part form.