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PERMfTTEE NAME/ADDRESS (InnY/r FrWgN?.arL«.New (/DIQGrwer) <br />ADDRESS <br />NAME RECE?vED <br />9 <br />FACILITY aPR O9 ?oOR,auOn. <br />LOCATION <br />.,swn 0i a d Safeh/ <br />• G n*MQ <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SY9TEM /INPOESI <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 />NOTE: Read Instrvctione before, comololina this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREG <br />UENCY SAMPLE <br /> O <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT z <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />E <br />E <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER ' "^"> ° `r prn. tr n 1, . ro:i this cl, menl and all ,t(whments were <br />TELEPHONE <br />DATE <br /> prepared ..it,, my direction or wperrhlon in accordance with , system desltned <br /> to care Choi quallned personnel properly [,Cher and evaluate the Info, w Ilon <br /> tarbmllted. Bred am m7 Inquiry of Che person or periams who manage the system, 1 <br /> or Those persorn directly respo"ble for gathering the Information. The Inrormation - <br /> wbmtlted Is, to the brat of my knowledge end beNef, [me. accurate. and complete. <br /> 1 am swan that there am sttntilunt penalties for wbmltting rate Information. SIGNATURE OF PRINCIPAL EXECUTIVE <br />TYPED OR PRINTED Ineiudint the possibility or Brae and Imprisonment for kno.ing Idatlons OFFICER OR AUTHORIZED AGENT CAREA ODE NUMBER YEAR MO DAY <br />COMMENTS AND LAI L.ANA I wn yr r+n T v1Vt.PC 11Vrga Irrerrrance an arracnmsnrs nere) <br />-r; ..- rr T C r c: '>. r r^ -rr <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. This is d 4-Pert form. PAGE OF