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FERMITTEE NAME/ADDRESS(? rAkF«Wy.Nams?Ler.rtan(/D(fbw) <br />NAME <br />ADDRESS <br />BOX 483 <br />•:IA CC 814-2 <br />FACILITY E 11J1D. c MIhIL <br />LOCATION I A C CI 8142 <br />I TAM A RFAR AR MTNF MGR <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDESI <br />DISCHARGE MONITORING REPORT /DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved. <br />OMB NO-2040-0004 <br />i I'•L.iR <br />(SU13P <br />F - FINAL DELTA <br />SR; DEER FRL DTC OR UNMD TRIB <br />NOTE: Reed klatrucdone before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREOUENCY SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE Y <br /> MEASUREMENT <br /> PERMIT t .; <br />i ?. <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT sr;; s t.;? r x _ -, <br /> REQUIREMENT I : ;t ! '' i a <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ? - <br /> REOUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT u s ..r # # s #. mac.; •? :? fl N C E i. . <br /> REQUIREMENT 30DA [ TH <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT #?rir , : n n s . <br /> REQUIREMENT AX, <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />t REQUIREMENT I L_' ; X <br />- <br />- <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT R 17 REPORT <br />REQUIREMENT TR MAX <br />NAME/TiTLE PRINCIPAL EXECUTTVE OFFICER ' mri'ly under penalty a ow that this document and all ttwhmeret. were TELEPHONE DATE <br />prep-d and- my direction or wit. lalo , In arcortl- with a system designed <br />to assure that qualified personnel property gather and eratuale the Information <br />wsbmltted. based on my Inquiry a( the person oe prmoru who manage the sysirm, <br />or those perswu directly mitonsible for gathering the infortnalloa. Iht Inrormatltm _ <br />atrbtedlied Is, to the best or my knowledge and bellef. IrLe, wortirste, and complete. _ <br />I am <br />- that th <br />r <br />Nfi <br />t <br />lth <br />b <br />I <br />SIGNATURE OF /RINCI?AL EXECUTIVE <br />f <br />diti <br />f -- <br /> <br />TYPED OR PRINTED a.; <br />en an> <br />ean <br />pena <br />s <br />or aa <br />E <br />s <br />ng <br />abe <br />nrormadon, <br />inrfudin the passibility or fine and Imprisonment for knowing rlobUoem <br />OFFICER OR AUTHORIZED AGENT A A <br />CODE NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference eN errachments here) <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used This 1S a 4-part Conn. PAGE OF