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PERMITTEE NAME/ADDRESS(/we&kf ray/vow.tLnr.tia (!D(,4 <br />rwg <br />NAME <br />ADDRESS <br />..'r. P7,9 C?0 8164 <br />FACILITY 1WYO M- NE <br />LOCATION <br />!Z S.,G S.1 4-4 <br />NATIONAL POLLUTANT OISCHARGE ELIMINATION SYSTEM //NPOE3f <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE Nwelpt <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Foam Approved <br />OMB No 2040-0004 <br />NOTE: Read Instructions before completing this form. <br />PARAMETER <br />QUANTITY OR LOADING <br />QUALITY OR CONCENTRATION <br />NO. <br />FF14O <br />ENCY <br />U <br />SAMPLE <br /> 1>< O <br />F <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX I <br />ANAlrsts TYPE <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT V <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT r . h O R ? <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT .:rh#.+ E- 'T <br />- REQUIREMENT <br /> SAMPLE 4 . ,. <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT * .`.' = T MAX <br /> SAMPLE ?.. <br /> MEASUREMENT <br /> PERMIT c:;?7pr?- ##dr <br />- ;t..- . REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> r <br />NAM TLE PRINCIPAL EXECUTIVE OFFICER I n <br />tt,y under pena ty o sw th.t this doromenl and dl .tlarhmenb were <br />TELEPHONE <br />DATE <br /> prp.md under my dirsctlon or superelslon In aeeord.nee with . system designed <br /> to aare Ih.1 rtu.l+ned personnel isropeA7 Lather and ee.lu.le the Inhnntallon .' ?! . <br /> submitted. E..ed on mt I"utry *(the Peron or persons who "note the system. <br /> <br />_t <br />L <br />' <br />" <br />? or (hose perore directly respenslbk for gathering the Infgnnalo4 the Inrorwrtbn <br />f <br />., <br />! <br />_ <br />? ( ' : ?. i r %_ <br />'-j r- submitted K to the best ormy knowledge.nd belirf• trw, wmmle. and tornPlete. ?_` - / ,J ?. / 1. <br /> i .m.w.r that them .r sitivWksm penNtles for submitting raise Inrorete.lbn SIGNATURE OF PRINCIPAL EXECUTWF <br />r <br />TYPED OR PRINTED . <br />Irt[1s,dlrtt the po.dbniry of fine and Imprisonment For kno.IrK .Id.tlores OFFICER OR AUTHORIZED AGENT A ANUMBER <br />ODE YEAR MO OAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference ell stlachmenls hers! <br />r``JEi < Apr, <br />a, J h, I k? IN -4 14i - :d U U kt 6 <br />EPA Form 3320-1 (Rev 3/99) Previous editions may be used _' ? / 1104944-1%" --form. AGE OF