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<br />Approved <br />Florm <br />PERMITTEE NAME/ADDRESS (7.c" r mbryN..?Lorauar t/D(Qiwsn) NATIONAL POLLUTANT OISCHAAOE ELIMINATION SYSTEM WDESI <br />ISCHARGE MONITORING REPORT (DU R) OMB <br />MB No. 2040-0004 <br />NAME D <br />ADDRESS ? r? <br />L <br />POX 4 PERMIT NUMBER DISCHARGE NUMBER F I fxiAL <br /> ' )E L OTC OR UNMD ' R I U <br />ER <br />P <br />IA O MONITORING PERIOD •. <br />1 <br />FACafTY ; NG c MINE YEAR MO DAY YEAR MO DAY - <br />LOCATION IA C O E' FROM TO <br />NOTE: <br />Read {netnlctloxw before completing this form. <br /> NO FREOUENCY SAMPLE <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION . OF <br /> EX ALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS AN <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT #•#•ii ?i )r -: v#ieii # # r_• i i Sri iFiE 4. t_I E E K L Y N5't'f!. <br /> REQUIREMENT <br />Ill I N I NUN <br />MA X I ilUlri <br />_ <br />IIJT GAC l' <br /> <br />i •.l SAMPLE <br />i, MEASUREMENT <br />`Ivll? .: ##i- <br />`-: ?'j j <br />- f .i'ji•;; _F?F+4It <br />..l 1 PERMIT 3.'##iF?t••14 i;'E-'R### # .: :y - _. . <br /> REQUIREMENT DA1LY MX MOW H <br />I1E SAMPLE <br /> MEASUREMENT <br /> PERMIT ### > 'ktFi?r# t - #r . REFFOF- REF OR T N: <br /> REQUIREMENT 30DA A', ' '•',,% l i_ Y MX MONTH <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT r;(x,: ###?i#3 :: 3F#„ _VQO 6000 NC-: A <br /> REQUIREMENT 3r)DA 4 V LEA I L'y' f <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT N 77 <br /> REQUIREMENT I ,4ST MAX <br />iR SAMPLE - i r :ri' #iii- <br /> MEASUREMENT <br /> PERMIT R i-p._tF REPORT <br /> <br />Y I REQUIREMENT -;,-?%I LY MX <br /> SAMPLE <br /> MEASUREMENT <br />- <br />- <br />- <br />-7 7 i <br />7 <br />r • <br />r <br />PERMIT -? ;= :, : . <br />REQUIREMENT _ <br />NAME/TiTLE PRINCIPAL EXECUTIVE OFFICER I m,10y a er penally Is> th.t lhh docvmenl and .11 .uachments were TELEPHONE <br />prep.ced ruder my dlreetlon or wpe l Am In .teordence with . syrlern designed DATE <br />to swum that gYdlfled personnel pro"AJ galher and eyaluele the Infnrm ellon <br />wtbmltled. Bred on my Irpulry of the person or person who manage it. syste,m <br />or these, persons directly mpomilble for gathering the Informalon, the Inform.tlon <br />.U bunted K to the best of my k-Wgt and beW, true, . mle. and compiett. <br />F PRINCIPAL EXECUTIVE <br />GNA <br />U ?- <br />- I am aware that them am slgnlllcant penaltirs for ewbmltting false Information, SI <br />T <br />RE O AREA <br /> <br />NUMBER <br />. <br />YEAR <br /> <br />MO <br /> <br />DAY <br />TYPED OR PRINTED Including the posdbltity of nm and Imprisonment ror ?nowing ridWti OFFICER OR AUTHORIZED AGENT CODE <br />COMMENTS AND EXPLANATION Or nnT VIWL- tuvr.a 1rt41`1arancw o, w..w.•••.•-...? ••-• <br />apFr ,o cl,1-r;T I9 CALMED IF. CLAIM APPROVED BY WGCD, <br />EPA Form 3320-1 1Rev 3199) Previous editions may be used This is a 4-part form PAGE OF