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PERMITTEE NAME/AODRESSam"F.rwryl?'..?tae.,r,,uDlpG..nr? <br />NAME <br />ADDRESS <br />hL' AER <br />FACILITY -;WYO 1111 I <br />LOCTION -< Er 0 E <br />i_Y L) V1= OF Of <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDESI <br />DISCHARGE MONITORING REPORT (D R1 <br />PERMIT NUMBER [D. EA10E NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM <br />TO <br />?_l I " I I <br />Form Approved <br />OMB No 2040-0004 <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. NCY <br />FREQ SAMPLE <br /> UE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - _r "V <br /> REQUIREMENT D A.." <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 /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br />PERMIT <br />REQUIREMENT <br />NAME TlE PRINCIPAL EXECUTNE OFFICER I nn.q under pema 1j m aw that thh doroment and an wischmenu .en <br />TELEPHONE <br />DATE <br />prepared render my dl reetlon or super.haon In aceordann with • yfytem designed <br />{ J f to amrn that quanned perwnnea property gather and etaluate the I .rmatlon <br />submitted. Bawd on me Inquiry of the Person or penorn who manage the system. <br />t <br />or show perseru dlrecily mporolble for gathering the In(ormntlen, the Inform allon - I <br />/( r ? i . " _ 1 ( /"I? ii r .r ?! L__ sYAMtted K to the best of my kno+kdge and belief. Irov. a rule. and complete. ? G { l? ( {j <br />! ! ?! <br />I am aware that then an sloftant Penalties for submitting fate lnforrmtloa. SIGNATURE OF PRINCIPAL EXECUTIVE <br />TYPED OR PRINTED Inrh.dlnt the Possibility o(Ilne and Imprisonment for knowing violation OFFICER OR AUTHORIZED AGENT NUMBER YEAR MO DAY <br /> CODE <br />COMMENTS AND It XPLANAI ILIN Vr ANT VIVLA I IVrvs [HeferenC• let alrttarchments horarl <br />•tR PRFC 7 P FV-ENT T=, CLAT"'FT' T C LAiI?? <br />EPA Form 3320-1 (Rev 3/99) Previous editns may be used <br />This:.WA-4-pan form AGE OF