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PERMITTEE NAME/ADDRESS pweids f.rMuy Neaee/Leerra? t/D(ditrwsr) <br />NAME <br /> <br />ADDRESS <br /> KHR (7 <br /> OWYO 1"1 7 NE <br />FACILITY <br />R C; <br />Kr <br />LOCATION . <br />; <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDE.3) <br />DISCHARGE MONITORING REPORT IDMR) <br />PERMIT NUMBER DISCHARGE NuM8ER <br />MONITORING PERIOD <br />YEAR MO DAY L)LEA!B 1. MO DAY <br />FROM TO <br />Form Approved <br />OMB No 2040-0004 <br />r - FINAL <br />GOSSARD PONES TO WILSON CH <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, <br /> <br />EX FRECUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> <br /> SAMPLE <br /> MEASUREMENT <br />c7 r <br />_ PERMIT DA I L.'t` !1 <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 />NAMERTTLE PRINC PAL EXECUTIVE OFFICER t cersuy r rr pens ty o law that this document and eN ottachment, were <br />TELEPHONE <br />DATE <br />prepared under my direction or supervllon In ateordance with • fyalem designed j <br />to aware that qualified personnel pro".1y [other and evaluate the Infnrmallon / <br />wrbmlited. Eased on my inquiry of the person or pervom who manage the system, <br />.-r? <br />or Ibose persom dimlly rvnpomfble for gathering the Informatlon, the Information ?? "? 1 ?, f • <br />?? <br />, <br />m adited Is, to the best of me knowledge and bttlef. true, acevnle. and complete. <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />I <br />b <br />l <br />l <br />1 <br /> 1 em aware that there are slgnifkewt pmaltlea for m <br />m <br />lnng fa <br />se <br />nfonmtlon, AAEA <br />TYPED OR PRINTED Including thr po?blllly or fin, and Imprisonment for knowing rlolatlon . OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION. OF ANY VIOLATIONS ffleference a# attachments herel 4HR PRECIP EVEINT IS CLAIMED. IF CLAIrl APPRUVk..L, uY W{ICD: <br />.. .°!` •.i _r-r. ..?ir7yc-. <br />iI ON <br />J' This`is a 4-part form. PAGE OF <br />EPA Form 3320-1 (Rev. 3199) Previous editions maybe used