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PERMITTEE NAME/ADDRESS (Include Fonliry Nmne/Inrsnon yDl$erenr) <br />NAME r :;, i'i'hk `I:7I •+~:. I"•~:. <br />ADDRESS r .. r, .~ ~ ~ h ~ _, <br />.... .... 1_.f <br />FACILITY n' y C ~ ~ 1 ~ ', <br />LOCATION <br />. r I~ f. lr 4 t' i/ .r' <br />NATONAL POLLUTANT DISCHARGE ELIMINATON SYSTEM (NPDES) FOnn ApprOVed. <br />DISCHARGE MONITORING REPORT (DMA) OMB No. 2040-0004 <br />a ^ , <br />PERMIT NUMBER DISCHARGE NUMBER _ ~ I ., n ~ , <br />MONITORING PERIOD .'~ ~~ i, e i 0 . l '. a ~i `: Url t. is '.; i.•:.. <br />YEAR MO DAY YEAR MO DAY <br />FROM i•: U TO J1 v.. !: -. .:1 'u I,'C':Pri .;:~ ~__~ ~..-~: <br />. •NOTE: Read Instructions belore completing this form. <br /> QUANTITY OR LOADING QUANTITY OR CONCENTRATION NO. FREO(/ENC SAMPLE <br /> EX of TYPE <br />PARAMETER <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS aNALrsls <br />,_. SAMPLE ~:.. ~x --:: :: :: .:. ,; ._... ., <br />B <br />~ ,.....~.:. <br />~~ ( L.~) <br />G ~ <br />~ <br />iNfif~ <br /> MEASUREMENT • <br />! ~)) 1. V ,' )., r <br />,~. ry .~ t+b.'-; <br />~0+,4~ <br />. <br />a~-r .4 - 4~Ka~4a OtKf ~ ~R ~ =d. <br />~ it ~ ~ r+~ ~r <br />~1~ <br />T~` <br />~r ~'Lri^ ~ ~J:i5 7aLU ~ ~ , ~~~~~trM ~ ~~~~~~}} ~}~} . <br />, <br />'l2 <br /> SAMPLE <br /> MEASUREMENT <br /> y, yn <br />SAMPLE <br />SAMPLE <br />~i r <br />1 ~ 'h. <br />. ). .,. ^~ <br /> <br /> <br /> <br />t - <br /> <br />;~ tom, <br />SAMPLE <br />SAMPLE <br />SAMPLE <br /> 1R14Y" u ,~ di'r d3?,*~si~ a ..fi~ ^gs. r, <br />r. r ?p!.. k.. f.: <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER ICenify under penettyalaw that this document and all etre,-hmenm we-e <br />r <br />ared und <br />r m <br />tliregi <br />n or su <br />ervision In a¢ortlance with a <br />m tlesi <br />t <br />d TELEPHONE DATE <br />p <br />y <br />p <br />gne <br />ep <br />e <br />o <br />sys <br />e <br />b assure Net quel~fietl personnel property gaNer end evaluate Ne inbrmation <br />w, loUCli~Tl'~ PeL2/rB submNetl.BesetlonmylnqulryalNepenonorpersonsvAOmuiegeNesystem, <br />or Noes persons tllreNy responsible br gelhering Ne lnrormatlon <br />Ne inbmrttlan ~/ ` ~/ ~/ <br />~<_/ ( 5~.~~-" ~ <br />~70-0::4-44Q1 <br />~1 <br />07 <br />25 <br />, <br />QSxs<kk~t F L""5 r .(i2Re Ia 1 Mann 7 e • <br />suomMetl h , ro Ne best of my krrowledge erW t>aNal, bus, accusers, and complete. <br />br <br />t <br />t H <br />l <br />m <br />t <br />ltl <br />b <br />lttl <br />l <br />i <br />1 <br />N <br />ro <br />a SIGNATURE OF PRINCIPAL EXECUTIVE <br />em aware <br />era ere s <br />gn <br />mn <br />pena <br />es <br />su <br />m <br />ng <br />a <br />es <br />n <br />nna <br />on, <br />a <br />TYPED OR PRINTED <br />Inoludino Ne oossibiliN of fns end ImgdsonmeM br knowing Notations. OFFICER OR AUTHORIZED AGENT ~~~ <br />r <br />NUMBER <br />YEAR <br />MO <br />DAY <br />rnMMPNTS AND EXPLANATION OF ANY VIOLATIONS !Re/erence all attachments here) <br />. ~~ ~~J:3L In.:iti LI' _T; -L L.. ~'.: w,{:. =J, d.'rl~ -r:*^i.`:&•~L.-. ... i ,. .. ~ . .li ,..- - r ...~ .~ :~V:., ,- <br />- r!i' .. JF' ~r.C]F' ~, h', Oi: crA Ct~I;. ,1; I. A. 3. P;. ". ... ~ - '. .. <br />EPA Form 3320-7 ~H~~ /J9~f previous edition`s may be used. ~ ` ~ - ~ ~ ~ ~ ~ ~ ~ ~ " ' ' ' , T}iIS IS A 4-PART FORM PAGE OF <br />i _ p <br />-- - - s <br />