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PERMITTEE NAME/ADDRESS Owlw& Fari6ryNwma?Lar0e00m UDfdlw+ro! <br />NAME <br />ADDRESS _ ii- <br />POX 48 <br />IA 51426 <br />FACILITY i NO. (? i I it <br />LOCATION ,,A I A Co 8 l 426 <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM INPDESI <br />DISCHARGE MONITORING REPORT /DMRI <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Forth Approved. <br />OMB No 2040-0004 <br />(SUBR <br />Y - FI <br />SR; DE <br />NOTE: Read Irastructlona before completlnp We form. <br /> FREOUENCV <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. of SAMPLE <br /> EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REOUIREMENT <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 />AL EXECUTIVE OFFlCER I Ce"'1` " er Pena ty o a- the, thb d«",nest a- .11 illarnmems .eat TELEPHONE <br />PRINCI DATE <br />prepared wader my dirertlon or wiper Wcet In arrerdanre with a system designed <br />P <br />NAME/TiTLE <br />to asswre that quanfled Personnel properly gather and evaluate the Information <br />submitted. Do" on my Inquiry of the person or persons who manage the system. _ - , <br />or those Per""' dlrmlly, mpordble for gathering the Information. the Information <br />submitted b, to the best of my knowledge and beef, true, a mle, and rumple t. <br />EXECUTIVE <br />IN <br />.. 1 am swan that then are slgrinnnf Penalties for submitting rebr Information, SIGNATLRE OF ?R <br />CNAL AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br />TYPED OR PRINTED Including the Possibility of nae and Imp 120 meat for knowing Aatstlmo. OFFICER OR AUTHORIZED AGENT CODE <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS fReference ap attachments herel <br />rF':T7 r,tr ;r „_ I a-^1FTj Tr ci M r,PPRn,"FD ?_3Y Wl?C <br />This.is a 4-pan fomi PAGE OF <br />EPA Form 3320 1 (Rev 3199) Previous editions may be used