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PERMI7TEE NAME/ADDRESS (!nclyde Facility Nmw/lacation iJDi$erenq <br />NAME <br />_..-l'. ~~.1 .. _ <br />ADDRESS I <br />FACILITY <br />LOCATION <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />.f_ - <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO ~~ <br />Form Approved. <br />OMB No. 2040-0004 <br />-- <br />NOTE: Read Instnictions before dOmpleting this form. <br /> QUANTITY OR LOADING QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br /> EX of TYPE <br />PARAMETER AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS 'WaL1Sls <br />e SAMPLE ~ ~ ~ ~. <br />- MEASUREMENT <br />ki ~sask; ~ t; PERMIT .~...-._ ... <br />_. <br />- .. T - a <br />, .. <br />~, U ~. . , - - - ~ .t REQUIREMENT <br />- ~-1j= o ~r .. ~ SAMPLE ~ ~ ~ ~ , <br /> MEASUREMENT <br />~ ~ r : 'r L PERMIT <br />_ ~, ~I ~ ; ~ - ~ REQUIREMENT ~ - • <br />_ <br />-. - _ _ ~ SAMPLE i -; - ~ ~ ~ -' <br />.. MEASUREMENT <br />r' _ PERMIT ~ ~• - .. <br />- r J ~ REQUIREMENT <br />-., <br /> <br />' SAMPLE i <br />r <br />r ~ <br />~ MEASUREMENT <br />r ' .. li i PERMfi . ; <br />- i ~ REQUIREMENT ~ r <br />i. - ~, ~. SAMPLE <br />- ~~~ MEASUREMENT <br />.. _ PERMIT ~ ~ .. .. ~ . <br />~ REQUIREMENT <br />~ ~ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMfi <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER ICaniry under penalty of law roar Nis document ono ell ettechments were ~~ TELEPHONE DATE <br /> preparatl under my alrenion or supeMSion In accoroence wlth a system oesignetl , <br />- -1 , \ <br /> <br />, W assure Nat qualified personnel properly Bather antl evaluate Ne Inlortnatlon \ _ <br />i.' <br />r .. : !' •~ <br />I ~ , > submlbetl. Basso on my inquiry of the person or pereorn who manage the system, <br />or Ihose pereona Glreclly responsible Tor gathering the iMormation <br />the inlormation ~ ~ !- ~ /.. ~ ~ <br />r <br />~ <br />= <br />r ~' ~ 7 <br /> <br />' , . ~ ~ <br />~ 1 I J <br />. ~ ~ ~ ~ <br />' ~ 9ubmitled Is, to the best of my knowleoge eno belief, true, aauraze, ono wmpleta. SIGNATURE OF PRINCIPAL EXECUTIVE ' <br /> <br />OR PRINTED I ern aware roar Nere are signRCant penalties far submitting false inbrmation, OFFICER OR AUTHORIZED AGENT NUMBER YEAR MO DAY <br />TYPED incluoin the sibili of fine and im nsonmem for krowi vloletions. <br />COMMENTS AND EXPLANATION OF ANY VIULA I IuNJ (Reference an artacnmenrs oars) <br />EPA Form 3320-1 (REV 3/99) Previous editions may be used. . J -. THIS IS A 4-PART FORM PAGE OF <br />