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PERMITTEE NAME/ADDRESS Uncludr Farihty :\'amdL~catian if (tiJfnrnlY <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />`.'; I EA <br />O f3 p 1 <br />t:s:l l~G4t <br />iVGINE~R <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES) <br />DISCHARGE MONITORING REPORT (D R) <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 />>` -- F z r~A~ ~? at <br />~;l)F~FP'"F RU~d!"iFF T(7 TRn11T ~:RE)r° <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION Np• FpEOUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE 4 ( <br />~ r3. }~' ~ t /~ I tJ `_. t T•-1 <br /> MEASUREMENT . <br /> PERMIT ~ ~ ._~ _ .. •. ,. r ,. i- _ ~ <br />• , r-, u <br /> REQUIREMENT i'1IPJ;T`I~._II~! •.,; :,: ; f~`-..'i• < i <br />H <br /> SAMPLE ~. I ~ ~ _ ! ~ ~ <br />"- ,...1,, u <br /> MEASUREMENT <br /> PERMIT ;. :::;•3 <br /> REQUIREMENT ~ ~ ~ %~-' ~''~~' <br /> SAMPLE ~ ~ I i ~. 1 ~~ i ,: ,- /-Q:4~ <br /> MEASUREMENT <br /> PERMIT .i ~ - _ -. <br /> REQUIREMENT ~ ' <br /> <br /> SAMPLE _ <br />~ / y <br />J <br />~ <br />~ I s~ ~ <br />~~ \P <br /> MEASUREMENT <br /> PERMIT ;~t .- .. .. ,- :,, t t. , ~, •_. ,. <br /> REQUIREMENT ~ i`~`~ri:? f-i <br /> SAMPLE ~ • <br /> MEASUREMENT <br /> PERMIT .. _ .. r ,• ;•. . <br /> REQUIREMENT <br /> SAMPLE ~r <br />'jJ <br />r! r\ <br />r-1 ,~ <br /> MEASUREMENT <br /> PERMIT s`~.; - ... ,_, - <br /> REQUIREMENT - '- `- ' <br /> SAMPLE <br />~~ ~ ~ <br />DI ~ <br />~ <br />~ <br />t /} ' <br />I <br />! <br />'TA <br /> MEASUREMENT ~ I <br />^ <br />- <br /> PERMIT -_ . _ _ t. - - - _ , ...> > . <br /> REQUIREMENT -~ .. ~ <br />NAMElTITLE PRINCIPAL EXECUTIVE OFFICER I n•rtiF vender prnalq t,t law thm thi. d,w•ument and au auarhment. wem <br />h di <br />i <br />ri <br />I <br />ith <br />t <br />d <br />l <br />d <br />i <br />d <br />~ <br />d <br />i ~' TELEPHONE DATE <br />_ <br />t 1 <br />~ <br />~ prnp:vrr <br />rr nt <br />rrc t <br />un nr wprr <br />un <br />n accnr <br />a ~~ <br />em <br />>Znr <br />un <br />~ <br />uncr M <br />~ <br />n <br />to a<.ure Ihal yuuliritd pa•rvmnrl proprrlc s;utbrr .md eaulmtte the information ~ - - - - - <br />~~ v t <br />\ <br />, <br />`t . <br />`} _ X ~ <br />~ Submiltrd. B:nrd on mr inyuin of the person or pervans who muno~e the crstrm. <br />\ <br />- nr th,na• prn,ms dirretly n-srymsiMe lar 4athrring tha• inf,rmation, thr information - _ <br />~ <br />~~ '~~%' ~`- <br />_ • <br />~~ ,ulmtitl vl i+. to the he+l of m~ knowlydLc and Iw•Ikf <br />rccurale <br />and complete. <br />True ~' <br />~ <br />: '~! J ~ S /~i ~ 11 ! <br />~~ - <br />, <br />-~ <br />r , <br />. <br />• <br />f <br />~ <br />~ SIGNATURE OF PRINCIPAL EXECUTIVE i <br />,• , „ <br />._ <br />TYPED OR PRINTED I nm aware That there an• si¢ni <br />m <br />nm pa•nnlo. <br />. G~r.uhmiuinR false infunn:amun. <br />h,dudin¢ the pos.ibiliq' or fine and impri,~.nmrm fur AnuwinF aidmiun.- OFFICER OR AUTHORIZED AGENT AREA NUMBER <br />CODE YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />EPA Form 3320-1 (Rev. 3!99) Previous editions t <br />ni C- - T}li• Iti a ~-part f(\rlTl. PAG! <br />OF <br />