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PERMITTEE NAME/ADDRESS (Include Fan(iry NamdLocamn jpgoeaq <br />NAME _. <br />ADDRESS ~ -~ . -. - ~ .: . <br />J ,~ J y <br />J C 1, _ <br />FACILITY - <br />LOCATION <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDESf <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />. r .-. . <br />Form Approved. <br />OMB No. 2040-0064 <br /> <br />~-~ ~ ,. <br />NOTE: Read Instructions before Completinq this torn. <br /> QUANTITY OR LOADING QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER EX of TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ANUrsrs <br />o SAMPLE <br />- MEASUREMENT ~ ' <br />,•,•+:. ~~ -. b ~ PERMIT ~-. ,,. .. ~.., - - - - . <br />r ' - - ~~ REQUIREMENT <br />' ~ ~- ~~ - ~ - -- - SAMPLE - <br /> MEASUREMENT <br /> <br /> REQUIREMENT <br />~_ :, SAMPLE ~ ~ ~ .. ~ <br /> MEASUREMENT <br />l . _ :I ( PERMIT - .... .. ~ .. ~ .. <br />_ I REQUIREMENT .. - <br />-- ~ . ~ ~ SAMPLE ,~ ~~ <br /> MEASUREMENT <br /> <br />"~ REQUIREMENT <br />r . L, . ' SAMPLE - <br />~r. ;; _~ MEASUREMENT <br /> <br /> REQUIREMENT <br />'• ~ SAMPLE <br />" MEASUREMENT <br />., .. ~ PERMIT _ <br />1 REQUIREMENT ~ ~ . . <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I Cerny untler penalry of law mat mis tlowment antl ell etterlimenis were <br />/ TELEPHONE DATE <br /> pmparetl untler my tlireclion or supervision in ecmrtlance win a system tlasignetl .- <br />'- '~ ~'..! ~ ~ , ,_ l to assure that quell0etl personnel properly g#her entl evaluae me inbrmation ~r ~,,; <br />I" ~ <br />' <br />' <br /> submittetl. Basetl on my Inquiry of me pereon or person who manage the system, ~ ~ <br />~ _' -~ <br />~ t ~ <br />/ <br />~ <br />. • ~ <br />~ <br />, or mole persona tlirecgy rasponslbla br gemenng ma inlonnatlon, me inbrmellon t ~ ~ ~ - ~ ~ r', ~~ <br />~~ <br />l L ~ ~ <br />- " ~ submmatl u <br />tome best of m knowled a 5nG beli <br />l <br />tr <br />r <br />t <br />tl <br />l <br />t l <br />~I I <br />~ <br />L <br />. , <br />, <br />e <br />ue, accu <br />a <br />e, an <br />con <br />a <br />e. <br />'y <br />e <br />p SIGNATURE OF PRINCIPAL EXECUTIVE I <br />TYPED OR PRINTED l am aware Thar mere era sign <br />fireM pen <br />llies for submittingralse lnlormetion, <br />inclutlin the osslbili of line antl im risonmant for knowin violations. OFFICER OR AUTHORIZED AGENT NUMBER YEAH MO DAY <br />wMMerv l a nrvu cnrlArvN l turv ur Nrvr vwu~ l lurva Ircererence eu anacnmenrs nere/ <br />EPA Form 3320.7 (REV 3/99) Previous editions may be used. THIS IS A 4-PART FORM PAGE OF <br />~ , -' - <br />