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PERMWME NAME/ADDRESS (Taso6k IrrWfyManse(L-a l- ((DWIsm-r) NATIONAL POLLUTANT OISCHARGE ELIMINATION SYSTEM //NPDESI <br />NAME DISCHARGE MONITORING REPORT (DMRI <br />ADDRESS jWYG t'I i lye PERMIT NUMBER OISCHAI{OE NUMBER <br />'I STA' <br />,AER MONITORING PERIOD <br />FACILITY <br />C1WYU (`' YEAR MO DAY YEAR MO DAY <br />LOCATION KER FROM TO <br />Form Approved. <br />OMB No. 2040-0004 <br />NOTE: Road Instructions bofw"0 pkthty thk fOfm- <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. <br /> <br />EX FREOUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT :r a:• . CI <br /> REQUIREMENT „ . •• T .• i, <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> T <br /> PERMI <br /> REQUIREMENT 1 v <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT { i? t G: hI C?'? <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT T N`%T I MAX '• <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> :.?. .., x-,? ; <br /> PERMIT - P.F 7.C. <br />. <br />... <br /> REQUIREMENT T ?.j <br /> <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />NAMEMTLE PRINC PAL EXECUTIVE OFFICER t Worry urckr penalty o law that this document r and all sit,chmcnu were TELEPHONE <br />dl rtcllon or supenlslon In sKCOrdance with . system designed <br />ared under m <br />re <br />• DATE <br />y <br />; <br />p <br />p <br />f <br />/ <br />/? <br />to aerrrt that ouaMfled prrgnrM properly gather and r•aluate the InfwmaUon <br />? <br />/;: /? <br />l <br />t <br />ry of the prnon w pemwn who rlranage the sys <br />em, <br />snbmilled. Based on my Irpu <br />I <br />•r 1 <br />l <br />' <br />! .- <br />'•' <br />`? <br />nforrnatlon, the Infon lion <br />w those perwm directly mspendbk for gathering thr <br />X <br />? , <br />` I l , <br />f i <br />I U ? <br />; <br />? <br />submtlled K to the b"t of my kno•rkdge and better, true. aresrrate. and ,ompktt. <br />PRINCWAL EXECUTIVE <br />R I <br /> I am awsm thst there art significant penaftles for mbmilting false InIbmnatlon, SIGNATU <br />E OF <br />THORIZED AGENT <br />A A A <br />NUMEIER <br />YEAR <br />MO <br />DAY <br />TYPED OR PRINTED Including the poalbley of floe and Imprisonment fw knowing violation. OFFICER OR <br />U COOF <br />COMMENTS ANO EXPLANATION OF ANY VIOLATIONS (Reforonce a# •FtacAments borol M <br />PF, <br />_LL~_ SEA=> - - Th(s`is a 4=part.fornI. PAGE OF <br />EPA Form 3320-i (Rev 3r99) Previous edibons may be used