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PERMITTEE NAME/ADDRESS (t,teit& FadboyMaw?L«ri- ((D(#6w t) NATIONAL POLLUTANT 04SCHARGE ELIMINATION SYSTEM //NPOES) <br />NAME DISCHARGE MONITORING REPORT fDMR) <br />ADDRESS <br />BOX qF? PERMIT NUMBER DISCHARGE NUMBER <br />'"]NIA MONITORING PERIOD <br />FACILITY ! I E NO. i i i'aG <br />YEAR MO DAY YEAR MO DAY <br />LOCATION 3N IA CO 131 FROM TO <br />. LLLIAM A. BEAR JR. MTNF It <br />Form Approved <br />OMB No 2040-0004 <br />MINOR <br />(SUBR MH ) <br />F - FINAL DELTA <br />CHROP41C WET TESTING FOR 006A <br />NOTE: Read Inetrucdone before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, <br /> <br /> <br />EX FREGUENCr <br /> <br />OF <br />SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ####3t ## REPORT #### f ##### - <br /> REQUIREMENT SI $ MP <br /> SAMPLE <br />R <br />T <br /> MEASU <br />EMEN <br /> PERMIT ###si## ##ittf#si Ler)(i r. o. #?:F ###### <br />..y... , REQUIREMENT !'{P1 c4 r;? ;i <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT u###!t# ?i#### REPORT ##iFat?k# iFir### l- Y <br /> REQUIREMENT $ INGSAMP <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - a 100 .r .. ###### rgLY O'NP- <br /> REQUIREMENT PIN VALUE <br /> SAMPLE <br />Ht' MEASUREMENT <br /> PERMIT REF OR T <br /> REQUIREMENT S I NGSAMF <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT .01 REPORT <br /> REQUIREMENT S I NGSAIIP <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT u - <br />REQUIREMENT <br />NAMEITITLE PRINCIPAL EXECUTIVE OFFICER 1 mr" r under pen. ty o New that this document and all atlachme,nh wen <br />TELEPHONE <br />GATE <br />pmpamd under my direct{on or Pups rrirlon In sccwrdattn with • syrlem designed <br />to swum that Quaiined Personnel proper{) ether and evaluate the Inrormallm <br />submitted. Dowd on my I"ulry of Our Person or pen d who mange the system, <br />or those <br />ersists directl <br />ms <br />etslble for <br />atherin <br />the Inf <br />stlati th <br />Info <br />ti <br />- - =? - -;- - <br />p <br />y <br />g <br />p <br />g <br />orm <br />e <br />rma <br />on <br />th <br />b <br />at <br />f <br />knowl <br />d <br />b <br />itt <br />d I <br />t <br />d b <br />a <br />f <br />t <br />l <br />d <br />l <br />t <br />su <br />m <br />s, <br />e <br />e <br />o <br />my <br />e <br />e <br />rwe. scrum <br />e. an <br />e <br />o <br />ge an <br />e <br />, <br />comp <br />e <br />e. <br />1 <br />fIGNATUAE OF PRINCIPAL EXECUTIVE <br />I <br />th <br />t Ih <br />11 <br />t f <br /> am aware <br />0 <br />em are 5 <br />cant Penal <br />ies for submitting fate Information, <br />a <br />TYPED OR PRINTED Including the possibility of fine and imprisonment for knowing violations OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference alt attachments here) <br />P -r ? F --HL TS rlr '_ ET!-iAL T T'r' DER I VS Ac 11 /EFF"ECT" , GRr)WTN, AND <br />GNi L <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used 1 / + TNS)- A 4,4-part (qrm. PAGE OF <br />t