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PERMITTEE NAMEIADDRESS lude FwelirvA'nnrr;lo ananifDifjrrvnU <br />NAME CER,',11NAL, 11`411 <br />ADDRESS LOADOUT <br />'7:_96 <br />'T SPRINGS C0 <br />FACILITY ;l•1L.Ct-i I_U!1LiG'JT <br />LOCATION I, u <br />!t- T r,iMl.:AI . rIP F=•rl ATr IIR <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (MPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Farm Approved. `'? <br />OMB No. 2040-0004, <br />r ? <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY <br />OF <br />SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT i f< a- . ,,. c ~ , r I <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 />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I cenify under is ,!hat this document and all attadnnenh were TELEPHONE DATE <br /> <br />pis Jones prepared under rn? dueci,n ,,r supar%iefon nt accnrdanre with a system designed <br />t assure than qualified personnel prnperl% gather and evaluate the mthrmahon <br /> <br />1 <br />M drolo ist I <br />y g submitted. Bawd on m%l mquvrv of the person or fxr ons ,eho m: na ge the awem, <br />or those persons dir fy responsible for gathering the int7amaiion. the infnmwtion <br />ect <br />'r - <br />9701 2. 6-5209 submitted Is. In the herd of my kno•,%ledge and belief. true. accurate, ,md complete. SIGN TUBE OF PRINCIPAL EXECUTIVE V <br />] <br />TYPED OR PRINTED n+rnmam fir ?wlanuns <br />rc <br />o sifin <br />d <br />m <br />l <br />d <br />th O ICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO AY <br /> e an <br />t <br />p <br />mc <br />u <br />trtg <br />e p COMMENTS AND EXPLArvAI Ivry ur ANT vluL.Al Iurvo Inererence an arracnmenrs Here/ <br />•tECIP EVENT SJL•JcCT T'D fiVRDEN OF PROD; RFQUIREt'!T=Ni=: i;d <br />TO TFfE DIVISION WITHIN 48 HOLI);S <br />EPA Form 3320-1 (Rev. 3199) Pretnous editions may be used. Jr??4? This t8 A 4-Part ft)nn.