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PERMITTEE NAME)ADDRESS(rweir6AMbryNalwarL«aiowIJD(A-#) <br />NAME <br />ADDRESS <br />CC b: tI2t <br />FACILITY vJIUE No nI ti t, ioUTh P:IuEz, <br />LOCATION A ej%L1!:ALCG ai?[t <br />.,1N I. r: r t: L J I. <br />Form Approved <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM /INPOES) OMB No 2040-0004 <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHAROE NUMBER A L <br />MONITORING PERIOD I% C(. LC E A L C F I ti <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. <br /> <br />EX FREOUENCr <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> <br /> SAMPLE <br />' MEASUREMENT <br /> <br /> PERMIT <br />- / <br /> REQUIREMENT <br /> N <br /> SAMPLE ) <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />t ? 'r <br />? L. <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT 3 .. 1. L <br />... I <br />a <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT A <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT r._;' ?feOF;'I c`SIS iASi?.t <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> <br />PERMIT <br />REQUIREMENT V " i <br />t ceridy under penalty olaw that this document and aY attachments were <br />TELEPHONE <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER <br />DATE <br />prepared under my dlreellon or wper.Mon In accordance with a system designee <br />to aware that qualified personnel property gather and eralusle the Information <br />wbmitted. Bred on my Inquiry of the person w persorn who manage the system, <br />• w those persme dlrerlly responsible fw gathering the Information, the Information <br />'.. _ <br />wbmilled h, to the best of my knowledge and belief. Irv*, a ralt, and mmptelt. <br />I am aw.- that there a- significant <br />enelltes for submittin <br />r.h. lnr <br />SIGNATURE OF PRINCNAL EXECUTIVE <br />U r <br /> p <br />g <br />onro <br />on, AREA <br />TYPED OR PRINTED lnctuding the posslbility, of floe and Imprhonment low knowing violation OFFICER OR AUTHORIZED AGENT ODE NUMBER <br />C YEAR MO DAY <br />COMMENTS AND EXPLANATION Or ANT vwLA I Ives (Ae/erence err ertechmenro here/ <br />EPA Form 3320-1 (Rev 3199) Previous editions may be used. This is 8 4-pari fOrTn- PAGE OF