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PERMITTEE NAME/ADDRESS ~Inrlude Farilits ,amt/Lora~ion if INf/ntnt7 <br />NAME ... _ _. .. <br />ADDRESS ( <br />FACILITY ;ii_,'- : '~1r'~ !'';' '~r_ <br />LOCATION ,A ~;;_~ ~ i 4~.~. <br />~RN~: E Wr?I'iF ,'i I NE ' iAivAGER <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 />Form Approved. <br />OMB No 2040-0004 <br /> <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ ~~ - .. . , .. ,, ,: . <br /> REQUIREMENT - - I" 1 s.; r f'ilJf•1 ~ .. <br /> SAMPLE <br /> MEASUREMENT <br /> PEAMIT Y . . <br /> `REQUIREMENT ~ - '~ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT _ _ _: <br /> REQUIREMENT =''-' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ... ..: -_ . ~ ~' . ~ ,_ _ <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - - _ ,- ,..- <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT .- -t: .- j<<::. -, ... ,_ ~ r-.. <br /> REQUIREMENT ' <br /> SAMPLE <br /> MEASUREMENT <br />- <br /> PERMIT . , ,_ ~ r' . - .. - ~ <br /> REQUIREMENT r. , ; :. ~ :.~ ,. <br />NAMERITLE PRINCIPAL EXECUTIVE OFFICER { crrii(s undrr penNi~l ~~riNw thNi Ihiti da'Umenl11f1d NII AIUn'hmenl+wrfe <br />lcr <br />o <br />'n isio <br />u•u <br />rr wnh n sssYem drsi <br />rl <br />d <br />di <br />r <br />ti <br />i <br />l <br />n <br />- TELEPHONE DATE <br /> prepare <br />um <br />nn <br />r <br />r <br />on <br />r mq <br />n <br />n a <br />n <br />un <br />R <br />e <br /> to Nswre Ihm yuNlifird penonnrl properly gN~hrr and e+uluNlr Ihr informution _ ---~~„ <br />- - --- ~ +uhmiltcd. BN.rd on m~ inquirl of the prrv~n nr ptnom who mNnuuc tt~e .~stcm. ~, ~ ~ ~ <br />i/ <br /> or those prraorx dircrtk rrsponcihle !nr RNthrrin~ Ihr information, Ihr infnrmNtNm - <br />r -~ - <br /> <br />~ ~ submNled i+, to the hest of ml Anowledite Nnd helkf, lntc, accurate, Nnd aunpkte. <br />if <br />lti <br />h <br />i <br />ti <br />I <br />th <br />h <br />i <br />f <br />itti <br />l <br />l <br />( <br />SIGNATURE OF PRINCIPAL EXECUTIVE ~ ~ <br />~ ~ - ~ ~ ~ <br />~ ~ .- <br /> <br />TYPED. bR PRINTED am awun <br />crc arc . <br />c+ <br />at t <br />ltn <br />irmu pcna <br />ur +u <br />m <br />nR <br />a <br />sr <br />n <br />nrma <br />un. <br />inrludin the sihilit~ o! finr Nnd fm rn rnmrnl !or know in i lalion+. <br />a qr P ~ u + ~~ OFFICER OR AUTHORIZED AGENT AREA NUMBER <br />CODE YEAR MQ DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />'tP'1:?" AF~t.7'~1_ ~r?R ~0't'R'24t-iR FRFf Tn ~.~I~M1i-•" _ ~r_c I A ^• <br />EPA Form 3320.1 (Rev. 3199) Previous editions may be used. - TI7f5 iS 3 4-p.ttt t~orrn. PAGE OF <br />