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PERMITTEE NAME/ADDRESSt7,-*-&FrMJYNaac?Loert-(/D(fL t) NAT1oNAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (INPDES) <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS <br />1 S T A T: PERMIT NUMBER DISCHARGE NUMBER <br />:ER <br />FACILITY JWyo M MONITORING PERIOD <br />LOCATION KKR FROM YEAR MO DAY TO YEAR MO DAY <br />- <br />L L Y (? <br />Form Approved <br />DMB No 2040-0004 <br />NOTE: Read Inetructlorn before completing this form <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREOUENCY SAMPLE <br /> OF <br /> <br />AVERAGE <br />MAXIMUM <br />UNITS <br />MINIMUM <br />AVERAGE <br />MAXIMUM <br />UNITS EX ANALYSIS TYPE <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT _i 0 . ! ... -r. ._ <br />_ REQUIREMENT -.: r%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 /> PERMIT <br /> REQUIREMENT <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER 1 [lull Y f penalty of la. Ihal IhH documenl and all allathment, .*r, <br />r <br />r <br />d <br />d <br />+ <br />l TELEPHONE <br /> <br />p <br />epa <br />r[el <br />e <br />un <br />er m d <br />on orsup-Won In accordance with a system eedpnd DATE <br />7C L i ) <br />C \f <br />' 7 <br />-- to aasur! that quatlnee personnel properly gather and evaluate the (nim mallon <br />- <br />/ <br />C. <br />' submitted. Bawd on my inquiry of (M <br />p<rsort a persona who nonage the sysurrti <br />o <br />thow <br />dir <br />tl <br />ih <br />? <br />1 r <br />1 <br />- <br />Z r <br />prn <br />y n pons <br />ec <br />ly for gathering the Inforsnallon, the lnfor llon <br />b <br />ltled i <br />t <br />th <br />e <br />f m <br />b <br />k C `_ /I <br />e - ) tr' ?y <br />- y <br />_ <br />% t <br />V - ' w <br />m <br />o <br />e <br />e <br />o <br />y <br />s. <br />nowkdEt and belief, true, n<vnle. and complet <br />I am aware that there are tiTNlkant penalties for mbmltnn <br />[ace <br />Inf <br />li <br />r, SIONATVRf <br />F P <br />INCW / .; . y <br />TYPED OR PRINTED g <br />s <br />o <br />m <br />on. <br />Incfuding the poodblllly of fine and imprlaonmenl for knowing .+olatlerea O <br />R <br />AL EXECUTIVE <br />OFFICER OR AUTHORIZED AGENT A A NUMBER YEAR MO DAY <br />n cvlat auATirlkt nC •/JV \/Inl aTtnuc CODE <br />?.vmmu?r.? nrsv ?... ?.-... r. ..?.. ?. ..... ..?..?...... r ... .. ....,. o...n ?...rrn?nt? nv?/ - <br />i L IMT 4HR PRECIP EVENT IS CLAIMED. Ir CLAIi^ F?rZC':':I ^`i GisrD <br />EPA Form 3320-1 (Rev 3199) Previous edibons may be used <br />_ 00 .,Q? /JIk0%4.A 4-pact iorn,. PAGE OF