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.. I <br />PERMITTEE NAMFJADORESS (include Fadfiry Nomcaocoaon ifl)iffa-wt) <br />NAME 'D <br />ADDRESS <br />FACILITY <br />LOCATION t-':=-S= • <br />NATIONAL. POUXTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMS) <br />PERMIT NUMBER Dism"Ge NUMBER <br />MONITORING PERIOD <br />YEAR I MO. I -DA" I YEAR I MO. I DAY- <br />FROM ZM1 C7 I A I I TO W131 oit 13W <br />Form Approved, <br />Im IN, ,•! R OMB No. 2040-0004 <br />F.�NAL <br />Nct <br />NOTE: Read Instructions before completing this form. <br />PARAMETER <br />QUANTITY OR LOADING <br />QUALITY OR CONCENTRATION <br />NO. <br />FREQUENCY <br />SAMPLE <br />>< <br />EX <br />OF <br />ANALYSIS <br />TYPE <br />AVERAGE <br />MAXIMUM <br />UNITS <br />MINIMUM <br />AVERAGE <br />MAXIMUM <br />UNITS <br />SAMPLE <br />MEASUREMENT <br />-7 <br />FTZ;-, <br />V4ALU""t <br />..,REQUIREMENT- <br />SAMPLE <br />-7J <br />MEASUREMENT <br />^S L U N -T G772SS <br />01D)AIA, V <br />:01-r--,,--"-,11-, il"; <br />G I L <br />1.01`4 T H' <br />SAMPLE <br />MEASUREMENT <br />-:P <br />3-77 --, <br />G17-10SS VA; -4RE01.11REMENT. <br />-01 DA -4 V <br />D 4 1' L 110v.' <br />KoNf <br />SAMPLE <br />701-Ai- <br />MEASUREMENT <br />I UUU <br />MICE, <br />27=' 'ENT r3FZFCS yc�-Lu= <br />REQUIREMENT. <br />30 DA, AIVG <br />ri C) N T 1- <br />- <br />SAMPLE <br />17 <br />7 <br />MEASUREMENT <br />PERMIT..' <br />V.,;' -u-='R'EQUIREMEW <br />SAMPLE <br />Vzj <br />MEASUREMENT <br />I.' <br />"OEFIMM,"' <br />IVIR-11r,"r-4 <br />-7177777777 <br />V -A L! <br />RJEQUIREMEWC <br />4! <br />SAMPLE <br />• S = L vi TH Z MEASUREMENT <br />47 <br />in 4, 7 <br />DATE <br />NAIMEMITLE PRINCIPAL EXECUTIVE OFFICER I -rary and- penalty ortow that t-higdocumvntand all azaaaMwere TELEPHONE <br />prepared under my direction orsupLryision in ward2n= with as"m de.%igned <br />to m=ft that qualirsed persoand properly gather and caluale am information C <br />emitted. Based on Noy inquiry of the pa-40 or persons who manage the systcnn, 1-41,x2j <br />or thoK- perwas directly rcVm%ibIc rot gathering the inforruntion, the information <br />Ve //I <br />submitted k to the beg or my knowledge and bellef, true, accurate, and complete. <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />I am aware that there -2rc mItairiciat penalties for %utunittimg: fal%c infortnatim <br />TYPED OR PRINTED including the pop;sibiliky orriat and imprisonment for knowing vlotadon . OFFICER OR AUTHORCMD AGENT AREA NUMBER <br />CODg NUMBER <br />YFJEA R MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />O*F PROCF 1REGUI MENTS <br />2-- --Z-,1=CT P 1EV=,NT Blk.t -2-, =07" —1 EUR'DEN <br />N <br />-7 <br />EPA Form 3320-1 (Rev. 3M9) Previous editions may be used. a ,OF <br />