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PERMITTEE NAME/ADDRESSpwd-A-Jrw u NaWL-oll 1(fD(A-1) <br />NAME <br />ADDRESS -rF H I GHW=, <br />FACILITY i I i- (?Ic <br />LOCATION '(Fib <br />'._L•Y I? SANDERS <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES/ <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER FDtSI.AIOE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved <br />OMB No 2040-0004 <br />ti <br />NOTE: Read kkstructitxks before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. NCY <br />FREG <br />U SAMPLE <br /> O <br />f <br /> EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br />REQUIREMENT <br />r : I <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br />REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT - - - ; <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />I cert,l) Y r pen. ty .(Is. that thh dortment and all .tlarhments were TELEPHONE <br />NAM TLE PRINCIPAL EXECUTIVE OFFICER DATE <br />pmpared under my direrilon or suprnlston In wcaManre with a "m designed <br />r! to assure that quanned prrsonnd Property gather and evaluate the Information <br />.ubmttted. as wd ss my lnqutry -(the Penou ar persons who -^age (he,rtem <br />f ' or those perm o directly mpomslbk for gathering the Information. the Infarmadon •? <br />submllted K b the best of m <br />knowled <br />e and belief <br />trm <br />-rate <br />and <br />kte <br />7 <br />g <br />, <br />. <br />. <br />romp <br />. <br />I ...ages that there arr sir ancam Penalties for arbmtltnng F.I. Imrormallon <br />SIGNATURE OF PRINCIPAL EXEC IUTFVE <br />TYPED OR PRINTED . <br />tnrhwilnr the paadWitty of nme and Imprhonment for knowing rtalatlom OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION Or ANY YIULAIIVN5 (RS/erencsNfsttschmentshers) iR PRECIP EVENT IS CLAIMED. IF CLAIM APPROVED BY WGCP <br />EPA Form 3320-1 (Rev. 3)99) Previous editions may be used - ThIS iS 8 4-pam form. PAGE OF