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PERMITTEE NAME/ADDRESS (/ncfrrde Fad!lry Namr/Loearion fDigerenr/ <br />nleuc <br />I~ - <br />.~. ,-_ .1, -. .. <br />~ ESS i -- ~' <br />r_ <br />r_ <br />~ ~ _ <br />TY . . <br />~rn <br />~ 'ION <br />~ I <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES/ <br />DISCHARGE MONITORING REPORT (DMA) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved. <br />OMB No. 204o-0004 <br />NOTE: Read Instructions before comoletina this form. <br /> QUANTITY OR LOADING pUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER EX of TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ~~/s <br /> SAMPLE ~ ~ ~ ~ ~ - ~ - ~ I <br /> MEASUREMENT ~ ~ I "' <br />.:. .. -. PERMIT _ <br />' ~ ~ REQUIREMENT <br />~~~~ - SAMPLE <br />... <br />~ .' <br /> MEASUREMENT j.'J v 7i ~ r r r r 1.; ~ / - <br /> ~ I . <br />:. ~ PERMIT <br />~, ~ , ~ REQUIREMENT <br />-. SAMPLE /. _ <br /> MEASUREMENT ~ 'J '. i7 r ~ t ~ <br />1.. _ PERMIT - - .. .. <br />~ , . <br />- ~~ ~ REQUIREMENT ~ ~ ~ - <br />a SAMPLE <br />' <br /> <br />, <br />MEASUREMENT <br />/;) <br />r I - - <br />... ~ % <br />I -, <br />.. <br />- . - ~ PERMIT <br />~ <br />~ <br />~ - <br /> REQUIREMENT ~ ' <br />_ <br /> SAMPLE <br />/ <br /> MEASUREMENT ~ %% -~ ~ i ~ <br />-( : -. ~ <br />' PERMIT <br /> REQUIREMENT <br /> <br />- .. - ~ " ,i SAMPLE ' <br /> MEASUREMENT r <br />.. ~ PERMR .. . <br />- - - ~ ~ ~ REQUIREMENT - <br />_ SAMPLE <br /> MEASUREMENT . <br />.; . 'I <br /> I . - <br />I PERMIT <br />~ <br /> REQUIREMENT ~. <br />~ ' <br />NAME?ITLE PRINCIPAL IXECUTNE OFFICER ICerVy under penalty of law Nat Nie document and all ehachments were TELEPHONE DATE <br /> preparetl under my direNOn or supervision in accordance wM a system tlasignetl <br /> to assure that qualiaed personnel properly gather and evaluate Ne inlormabon <br /> aubmtttetl. Based on ny Inquiry of Ills person or persona who marege Ne system, <br /> or those persona dlreNy responsible for galhedng Ure irttomiatlon <br />ere Inbnnation <br /> , <br />submitted le, to the best of my knowledge and boliel, true, accurate, end tomplale. SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED OR PRINTED I am aware that throe me sign~rarrl penaltlea for submitting lelse inbrmation, <br />Innuain me ossibili of fne and im risonment for knowin violations. <br />~ OFFICER OR AUTHORIZED AGENT <br />NUMBER <br />YEAR <br />MO <br />DAY <br />UUMMtN I S ANU h~YLANA I I V N V h AN7 V I V lA I I V N5 (HBlerenCe all BltaCflmBntS neref <br />EPA Form 332o-1 (REV 3/99) Previous editions may be used. ' ~ ~ ~ ~ THIS IS A 4-PART FORM SAGE OF <br />~~ - - <br />