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PERMITTEE NAME/ADDRESSIywe66ForibigN-OLxari-(fD(06+nq <br />NAME 1iJWYIJ =-''JAL CU `:i'HIVY, L t <br />ADDRESS OWYO 1-11 NE <br /> ''ci-FATE t-i? 1;' fiS, 'r <br /> .KER =C <br />FACILITY -0WYO 11 1 I'41_ <br />LOCATION =.KER CI <br /> I I Y I) ?ANT)FR VU OF <br />NATIONAL POLLUTANT DISCHAROE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR1 <br />PERMIT NUMBER DISCHMOE NUMBErt <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved <br />OMB No 2040-0004 <br />NOTE: Read kwtruetions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREDUENCr <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> <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 /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />A <br />th this dm.menl and all r 11whmente were TELEPHONE <br />TLE PRINCIPAL EXECUTIVE OFFICER i rerttty " nder penOil y o law <br />M DATE <br />prepared under my dirt tlon or n,per idon in eccordann with a System ddgned <br />NA <br />EM <br />to aswn that tluehllrd pe-l Por,y 921her end eSduale the Infoemallon - <br />' submitted. Based on my Inluley of the penoo er perntm rho -net, the system, - j ' ,. <br />// <br />,, <br />! . or thou pereom directly rvpun/b t for gathering the Infoemellon. the Inrormatlan ?/ <br />/ <br />( <br />Submitted b. to the best of my knowjedte and bender, tree. accurate. and complete. , V <br />IONATVRE OF PRINCMAL EXECUTIVE . <br /> 1 am -wan that then err dgnlMleanl prnalMa for sub"ifing faire Information, S A A <br />TYPED OR PRWTED Including the potdblnly of nne and Imprbonmrot for knowing "olaoon& OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS /Reforenc• eH •ffechmente herel 4HR PR>; C is P EVENT IS CLAIMED. 1F CLAIM API= RQVZ! $ Y WCIC D, <br />= t _' i' 10 N'; <br />EPA Form 3320-1 (Rev 399) previous editions may be used This it a 4-f1.'r f"y!" PAGE OF