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PERMITTEE NAME 'ADDRESS ,Inc(u&, I=acilin, Name Location rf nrfferenrl <br />NAME {;°t I r4A t I NI <br />ADDRESS ?•_ C f i LRADOUT <br />72996 <br />-'IT SPR I NG9 0 <br />FACILITY LOAEoDOT <br />LOCATION C LI <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPOES) <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 <br />T: F 1,NAL f• iTT <br />- - ;. r Ahgp,', <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, i FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />ME <br />S <br />REMENT <br />6 1 <br />l <br />} <br /> A <br />U ( Vc? <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE - <br />J <br />D <br />I <br /> MEASUREMENT '" L) Q <br />-- <br /> PERMIT t### its:iE#-4 70 <br /> REQUIREMENT .:, .. :3Qui; t` Lrri ' :.- . I <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT i #ii # *a c E iL R T <br />t. c ist . = % `-F, A!" <br /> REQUIREMENT 't?1 ci s' 1 <br /> SAMPLE <br />MEA <br />UREM <br />NT <br />vr <br />L <br />. s_ S <br />E , <br /> PERMIT ::Q # } - ittr# ii !: '4 r4a i 17..100 <br /> REQUIREMENT 3Crrr.:. <br /> SAMPLE ,i - ,> >t r •> <br />( <br />J <br />- <br />_ <br /> MEASUREMENT ) <br /> PERMIT ., lt., .. <br /> REQUIREMENT <br /> SAMPLE <br />MEA <br />UR <br />M <br />NT ?` <br />0 ( <br />J 16 <br />G <br /> S <br />E <br />E 7 <br />. • V L <br /> PERMIT REPO r fM -;tYr <br /> REQUIREMENT i .' <br />!i <br /> SAMPLE <br />MEA <br />UREMENT a -:;.? l I V ' C I iJ i? / <br />(? <br />JI C C/ <br /> S ( <br /> PERMIT ?,:#r# 7 x#a i?PT F1 F 0R <br />_ <br />'- rt.A <br /> <br /> REQUIREMENT <br />NAME.'TITLE PRINCIPAL EXECUTIVE OFFICER I _crr, under penalty of law that this d:nurnent and all attachment: were <br />d <br />d <br />d TELEPHONE DATE <br /> ante scut: a system <br />esigne <br />Prepared under my direction or super i,ion in accor <br /> !,,assure that quith ied personnel properly gather and eealaatc the ittiornwtion <br /> ,uhmitted. Based on my inquiry of the person or lxrsuus who manage the system. _ <br /> or those persons directly responsible for gathering the information, the utt.ernanon <br /> <uhmitted is. !'' me best of my knowledge and hehef, true- accurate. and complete <br />t <br />u <br />i <br />ln <br />f <br />b <br />mi <br />i <br />f <br />ti SIGNA RE OF PRINCIPAL EXECUTIVE i_- <br /> <br />TYPED OR PRINTED pcna <br />or,u <br />ng <br />orma <br />on. <br />I tin aware d 1 crc are signif <br />can <br />c, <br />mu <br />sc <br />n <br />t fo <br />m <br />ri <br />siutah. - <br />l <br />ni <br />h <br />f fi <br />d <br />k OF ICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br /> ty o <br />ne an <br />imprison <br />en <br />r <br />g <br />, <br />i <br />ng u:: I, •.. .i <br />n-, <br />inc CODE <br />COMMENTS AND EXPLANAIIUN Uh ANY VIULATIUNS (Reference all arracnmenrs nere) <br />- EVENT 2,IJRD'E!:I qF P?r?OF RE(9 !I RF-M <br />THF: DI'- <br />EPA Form 3320-1 (Rev- 3.!99) Previous editions may be used. 74 t?. This%;&?-part: £DIl