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PERMIT-TEE NAME/ADDRESS (Include Fat-&A• Nnmr.1rn7471iF'n t Pi#CMn0 <br />NAME <br />ADDRESS j •\t <br />FACILITY <br />LOCATION <br />3164 <br />IAmin F-p <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <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 />:. 1 <br />G UlL.CH <br />A <br />NOTE: Read Instructions before comoletino this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREDUENCY SAMPLE <br /> <br />? OF <br />TYPE <br /> - ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ".j <br /> REQUIREMENT I'I`'^! rF1 <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT S ' .1 <br /> REQUIREMENT <br /> SAMPLE <br />P ; f MEASUREMENT <br /> PERMIT <br />t. - REQUIREMENT ? ;'Il7fJ 7 Fi <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT r. s. iRAii <br />I <br />_ REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />r REQUIREMENT :3'OD ` TH <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT rJN" i N ' r, .. <br /> REQUIREMENT ^ ^ Y GEfd? <br /> SAMPLE :r <br />1 t - - - MEASUREMENT <br /> PERMIT - ' 'F' i G ?' * `' c [ nl _? I N <br /> REQUIREMENT T L <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I ecru(', under pcnalty of lai Ilai this d.aument and all attaclunenis were <br />v TELEPHONE DATE <br />?.. <br />_i'i?< r --• <br />(?? <br />, .- prepared under /m direction or super <br />ision in aceOMUTICe with a ?ystem designed <br />Io assure that qualifical persemnel pmperi% gather and evaluate the informatit>tt - - <br />• <br />- submitted Rased on my inquiry of the person or persons who manage the .system. <br /> or thox persons directly responsible for gathering the information, the infomlation - <br />t- i submitted is <br />to the list of m} knowledge and belief <br />true <br />accurate <br />and complete ' <br /> , <br />, <br />, <br />, <br />I sin aware that them are si <br />nificant penalties for whtntning talcs tnfomiau,?n SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED Obi PRINTED g <br />including the possibihiy of tine and impne.mmcnt for knowing violation, OFFICER OR AUTHORIZED AGENT AREA <br />CODE NUMBER <br />YEAR <br />MO <br />DAY <br />L,UMMCIY 1.7 MIVU r-Al" RNMI IUI`1 Ur MINT VIUl.M 11V19a Il1CICIC/1{.u all of IGL,11111011IS fiat t:l <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. <br />5WI LING 16155 Rt-ICTiON! <br />This is a 4-part form.