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~~ <br />PERMITTEE NAME/ADDRESS Ilntlude Atrilirt ,Yamdlocapun IJ UiJJI rl~nl <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />.... ' ' FROM TO <br />T ~QF'FC-' <br />Form Approved <br />OMB No 2040~(>'.~U~t <br />Ij~ <br />NOTE: Read Instructions before completing this form. <br />PARAMETER DUANTITY OR LOADING DUALITY OR CONCENTRATION NO, FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> ~ ~~ `~ ~~ ~ I I~ I~ ~ Iii <br /> MEASUREMENT <br /> PERMIT ~ .. .. ,' ~C ~-~ . <br /> REDUIREMENT ~ ~•~"'~~ ' <br /> <br /> SAMPLE ~ ~~ i J ,~ <'_ j ~:., fit' 1~ <br /> MEASUREMENT <br /> PERMIT ~ ~ ~ ~+ <br /> REQUIREMENT '~ <br /> SAMPLE ~ ~ /,~ _ 1 < T. 1 ~ ._ ~ ~~ C-_ I%JL3 <br /> MEASUREMENT <br /> <br />PERMIT -. - i-. <br /> REDUIREMENT ~`~ '' <br /> SAMPLE <br />•: -1.+~, <br />< . i.., <br />, f; > <br />~ ~ ~ ~ <br />L ~ ~S <br /> MEASUREMENT <br /> PERMIT ~` s ~ - <br /> REDUIREMENT 1 ` <br />' ` ~' ' I~'~ ~~ ~/-j ~~~~ <br /> MEASUREMENT <br /> PERMIT ' - .c; . , .- .. . + ~ _ . <br /> REQUIREMENT a~" ~'' ' <br /> SAMPLE <br />G~-- <br />G <br />O <br />C~~ <br />v2-' <br />~ ~ ~- <br />I ^I ;~~.1 <br /> MEASUREMENT . . <br /> PERMIT ~-.. : ~ , <br /> REQUIREMENT - _ - <br /> `~~ ~ I f ~ JI ~- -r~l,.., <br /> MEASUREMENT <br /> <br />PERMIT <br />~ ' ~ - 'r: ,. ~. t t f'IL. <br /> <br />REQUIREMENT <br />- _ <br />'~'hl" <br />NAMElfITLE PRINCIPAL EXECUTIVE OFFICER I certih undrr prnalt~ 1/f law that Ihi+dlaument and all attachmrnt+ were ~ TELEPHONE DATE <br /> preparrd undrr nq diraliun or wprnisiun in accordancr with a +~stem desi>;ned ~__ - - <br />~ ~ i 1 <br />- .~_ o~ awre that ywlificd per~llnnrl prnperh gather and e+aluate the infarmaGlm <br />suhmiaad. Nasrd nn mr Inyuir+ Ilr thr larruln or pervms who manage the sj stem. ~-'- ~ -' - - <br />' <br />~r <br />~ or (hl.w prr+lln+dirrrUy respalabk fnr KatherinK thr mf Irnution. Ihr mfnrnutlon _ ~~ ~ ~ -- <br /> <br />r <br />h <br />In the heN hf m <br />knl.w lvAkr and hrlkf <br />true <br />aculrnte <br />and avm <br />kte <br />illad is <br />'- ~ - '~ 1 ~-~ i -, <br />i~ r ~ ~ <br />c+~ <br />- <br />\ <br />~ L -~ <br />- ~~ ~ <br />, <br />, <br />, <br />p <br />. <br />u <br />m <br />. SIGNATURE OF PRIN(~,IPAL EXECUTIVE - - <br />y <br />- f •rm awarr That them un .iynifnanl penalties fur +ubmrttinK (ahr information. <br />win <br />+i <br />s <br />bdi <br />f fi <br />m f <br />l <br />tkl <br />h <br />t <br />h <br />d <br />k OFFICER OR AUTHORRED AGENT AREA NUMBER YEAR MD DAY <br />TYPED OR PRINTED e x+l <br />q o <br />ef an <br />Im nurtlme <br />or <br />no <br />g; <br />o <br />a <br />a <br />, <br />inc <br />a <br />in t <br />>; w p <br />COMMENTS AND EXF'LANAIIUN Vt ANr vwL.vtllurva frrererence aft arracnmenfs nereJ <br />EPA Form 3320-1 (Rev, 3199) Previous edtiorls may <br />~}')tl~ IS 8 4-part fClim. <br />