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PERMITTEE NAME/ADDRESS (include Facdirv.Name ocation if thfferem) <br />NAME <br />ADDRESS <br />C(I 81639 <br />FACILITY c C01-1PLEX <br />LOCATION AIL N t. 0 B 1634 <br />v, AR n, I= AT Tnt\i MANAGER <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 Y AR MO DAY <br />FROM TO <br />MINOR <br />(SUPR JC <br />F - FINA <br />D CHO TC <br />Form Approved. <br />OMB No 2040-0004 <br />• ! <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> <br />SAMPLE <br />?? I - I' <br />! <br /> MEASUREMENT I <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE r <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT - t•: <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT J <br /> PERMIT Ir. <br /> REQUIREMENT <br /> SAMPLE <br /> <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />J Ui <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />?lJ <br /> MEASUREMENT - I <br /> <br />PERMIT _ r. <br /> REQUIREMENT <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER I certify under penalty of law that this document and all attachments were TELEPHONE DATE <br /> prepared under my direction or supervision in accordance with a gstem designed <br /> to assure that qualified personnel properly gather and evaluate the information <br /> submitted. Based on my inquire of the person or persons who manage the system. <br /> or thieve persons directly responsible for gathering the information. the information <br /> lete <br />b <br />best of m <br />knowled <br />e and twlief <br />true <br />accurate <br />and com <br />s <br />itted I% <br />to th <br /> y <br />g <br />. <br />, <br />, <br />p <br />. <br />u <br />m <br />, <br />e $IGNAT RE OF PRINCIPAL EXECUTIVE <br /> I am aware that then- are significant penalties for submitting false information. <br />%iolatio <br />ibili <br />f fi <br />d i <br />i <br />t f <br />k <br />win <br />d <br />h OFFI ER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br />TYPED OR PRINTED p o <br />ne an <br />mpr <br />sonmen <br />or <br />no <br />g <br />m. <br />inclu <br />ing t <br />e la? <br />I CODE COMMENTS ANU tANLANAIIUN Ul- ANT VIVLAIFVNZ7 (Pfeferent:e <br /> <br />HR PRECIP EVENT SUBJECT OF BURDEN OF <br />L . <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used