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PERMITTEE NAME/ADDRESS rlnclude F"&Y A'amelLocanon if l ifffrrni NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS <br />PERMIT NUMBER DISCHARGE NUMBER <br />FACILITY MONITORING PERIOD <br />LOCATION f; n `3 1 6 YEAR MO DAY Y R MO DAY <br />_ 2= t, FROM TO <br />KARn A'IA77.-7!N i"4RNAG! <br />Form Approved. <br />OMB No. 2040-0004 <br />(5. ? s <br />F - FINAL RD <br />DSCI-iG TO TRIBIDity LRP-.EK <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE j i <br /> J /`f • <br /> MEASUREMENT J <br /> PERMIT <br /> REQUIREMENT C - - <br /> SAMPLE <br /> MEASUREMENT J v <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 />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER I certih under lKnalh of law that this d«umrnt and all attachment. -m <br />r <br />ed toad- m <br />dir <br />ti <br />o <br />rvi <br />with <br />n <br />i <br />i <br />d <br />t <br />d <br />i <br />d TELEPHONE DATE <br /> p <br />epar <br />% <br />ec <br />on <br />r supe <br />on <br />n ac ew <br />ance <br />a ge <br />em <br />s <br />es <br />e <br />g <br />to assure that qualified Personnel properly gather and esuluate the information <br /> .uhmiued. Bused on ms inquire of the percnn or per rts who manage the satrm. . <br /> or those per.(ms dirmth m ixmsihlr for gathering the information, the infnrmatkm ? <br /> suhmm d is. b, the hest or m> knowledge and belkf. true, accurate. And complete. <br />I <br />un an th <br />t ther <br />ar <br />i <br />nirica <br />t <br />e <br />lti <br />, fo <br />sub <br />itti <br />f <br />e i <br />for <br />tion <br />l <br />SIGN URE OF PRINCIPAL EXECUTIVE <br /> s <br />, <br />a <br />e <br />c s <br />g <br />n <br />na <br />r <br />m <br />ng <br />a <br />n <br />ma <br />, <br />p <br />e OFFICER OR AUTHORIZED AGENT AREA <br />TYPED OR PRINTED mdoJw th. Possibilihof fine and imprt onmrm for knowing siolatinns. CODE NUMBER YEAR MO DAY <br />GOMMtN I5 ANU tAFL.ANA I IUN UI• ANY vIVL,A I IUNa (rfererence an arracnmenrs nere) <br />YDc <br />ASONABLE POTENTIAL ANALYSI <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. "'-' -This is a 4-part fbnn.