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PERMITTEE NAMEIADDRESS Ihlrl;,dr l'ori/tJr:\'amrll<Iratinn i/fhfJnen71 NATIONAL POLLUTANT DISCHARGE ELJMINATION SYSTEM ((NPDES) <br />NAME ,}~` _ ~_ _. DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS <br />8L7;( PERMIT NUMBER DISCHARGE NUMBER <br />FACILITY 'Lii-I MONITORING PERIOD <br />LOCATION YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved <br />oM6 No. 2oaaoooa <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />L SAMPLE - <br />I ~~ ~~' MEASUREMENT <br />- PERMIT '= s•. ', :- ..: c~ _-.~_;-;~ -r ~ :_ <br />- REQUIREMENT s l'~i ~ ` i1,<+i X ~ < -? =- ~ , - <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 <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I ;rltif) under penau> of m. that this draumeat undrll xtlachmrnt. wen <br />prrpurrd wider m~ dirra4ion or wpeni+i~ul in accordance with u z. item deciltlled TELEPHONE DATE <br />__~-- ------ In a+surr that ytlalified pt•r+nnnel prvlprrl~ Rather and r. aluatr thr information ~_ ~ - - <br />_-... .uhmlttld. Ra.ed un m~ inyuin of thr per.un ar peru>n+ who mannXe the .}Hem. ~ <br />~ <br />`~ <br />~ <br /> nr tho.r person. din.•tl~ mplmsihlr for gvthenng thr informatiun, thr fnformutinn ~-~ <br />I <br />' _ <br />~ <br /> <br />.ubmittnl h, to the Fist of ms knowledKr and helirf. trur, a curate, and .vmpktr. ,~ ~ <br />~~ <br />1 <br />r• ~ ~ <br /> <br />1 am aware that thrre are signiRcam penalties for suhmittinR false in(ornlution SIGNATURE OF PRINCIPAL EXECUTIVE r` i ~ <br /> <br />TYPED PRINTED . <br />includin>;thrprls+ibilihl:ffinrundimprronm.•ntforknouin~.idutinns. <br />OFFICER OR AUTHORIZED AGENT AREA <br />D NUMBER <br />YEAR <br />MO <br />DAY <br />1„VMIYICI\IJ MI\V Gnr'GNI\MIIVI\ Vr MI\t YIVL/111 VI\J Ir1CICl C/It:C QIl OIIa[:IIIIIClI1J rICl C~ <br />~ ..-, - r. - . -. - ~ - - .-. ~ r i ~ i x t ^1 <br />EPA Form 3320-t iFev. 3.99) Previous editions may be used. tJ453c• TI1iS is a -~-~~ttt 1h~1t1 <br />