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PERMITT'EE NAME/ADDRESS47m"Jr.rdlgNw.?L«eti nsfD(06. t) <br />NAME <br />ADDRESS <br />FACILITY '-%`Y r v t-t ::vc. <br />LOCATION KKR 0 E <br />j-LY D. SANDFRS, VP OF Of <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (/NPOES) <br />DISCHARGE MONITORING REPORT (DMR) <br />I I <br />PERMIT NUMBER DISCHARGE Numem <br />MONITORING PERIOD <br />YEAR f]MO DA YEAR M DAY <br />FROM TO <br />Form Approved <br />OMB No. 2040-0004 <br /> <br />NOTE: Reed Instructions before completing this form <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO F"'Q'O NcY SAMPLE <br /> <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br />_ REQUIREMENT Pert !!-Y <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 /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> t -"'y " <br />° ¦. Choi 1h <br />r"a l <br />nd" <br />H dorvmrnl <br />d V <br />NA EMTLE PRIN IPAL EXECUTIVE OFFICER an <br />P <br />¦ttachmrnls were <br />y <br />i <br />i TELEPHONE DA <br /> <br /> <br />- <br />prepared antler me direct <br />on or mp"v <br />lon In smrdance with ¦ system designed TE <br />, <br />( to *mum that qualified personnel Property gather and resiusle the Information <br /> <br />1 submllted. Board on my inquiry or the person or persons who manage the system, <br />or Iho <br />r <br />di <br />tl <br />dbk f <br />th <br />I <br />- <br />'" <br />/.•, 4j ? <br />:/)--- w pe <br />sona <br />rec <br />y mpon <br />or ga <br />ering the <br />nformation. the Information <br />ub <br />tll <br />d ) •[: <br /> s <br />m <br />y <br />I& to the hest of my tnowkdte and belief, true. accurate, and compkle_ <br /> 1 am aware that there are significant penalties for suhmllting fake Information. SIGNATURE OF PRINCWAL EXECU•I1VE <br />TYPED OR PRINTED Inrtudlnt the possibility or flew and Imprlfonmeni for knowing "olatloom OFFICER OR AUTHORIZED AGENT COOP NUMEIER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference ad arfachmonrs hers) iR PREC 2" EVENT IS CLAIMED. IF CLAIM A6'F <br />1;"FMEN`S SEE ? r• :mot <br />EPA Form 3320-1 (Rev 3199) Previous editions may be used <br />TAWiiS 1-part form. PAGE OF