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ItERMITTEE NAME/ADDRESS47.4-AF.*&Mn.?Lwwt.I(DWW,.w) <br />NAME <br />ADDRESS <br />=KER <br />FACILITY DWYC) <br />LOCATION 'KER <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM /INPOESI <br />DISCHARGE MONITORING REPORT (DMRI <br />PERMIT NUMBER DSCHARGE Nt1MSFA <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Foam Approved <br />OMB No 2040-0004 <br />NOTE: Reed kwtructlons before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ, <br />EX FREQOUfNCY SAMPLE <br />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 /> <br /> <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 />NAME/TiTLE PRINCIPAL EXECUTIVE OFFICER t "rely under penalty sr that thN docomenl and will attachments .ere <br />TELEPHONE <br />DATE <br />prepared coder my dlrtctbn a suprrehlon In accord ann rlth • system darned <br />th <br />l <br />l <br />lh <br />h <br />I <br />f <br />ftn <br />i <br />ed personne <br />proper <br />_ to assure <br />at qua <br />y ta <br />er and e•Nualc t <br />e <br />n <br />ormat <br />on <br />4 - s abmltted. Bared om my Inquiry, of the Person a persons rho manage the system, t <br />of then persae dl-lly responsible for gathering the Infortnallew, the Information - <br />4L wbmllled Is. to the bat of my knowledge and belief, true, aeevrate. and complete. <br />SIGNATURE OF PRINCWAL EXECUTIVE <br /> 1 am ¦- that there are dtNnunt penattles for submitting fain Inforrrrtlon. A A <br />TYPED OR PRINTED lnciudlnt the pmsslbnlty of one and IrrrprlsonnleM for hnorlnt .Idauasa OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference •N ertachments herd <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used This is a 4-part form. PAGE OF