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PERMfTTEE NAME/ADDRESS ilnrlude F«ilitt ~~'ank/Ltrcatinn if IhJJ'natll <br />NAME ~'~! . LAC <br />ADDRESS - <br />i+ax •~~S <br />s__AI CQ 8142R <br />FACILITY HCjft I ZC1f+l r1I N1= <br />LOCATION ,_ A ~ (~ E- 14 `~7 <br />! ANC'F WAT)F• Nf7PJE MANA~Eft <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 YEA MO DAY <br />FROM TO <br />Form Approved. <br />oMS No. 204aoooa <br />E 1=iR(;~ 3 ~ TUT <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION <br />NO. FREQUENCY <br /> <br />OF <br />SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE i <br /> MEASUREMENT <br /> PERMIT F <br />~ - r r •. -.~ ~ ~ i , .V .. / ,. <br /> REQUIREMENT - . =':% y DAILY hl :' !'.: '' 1'Ii7~ITf <br /> SAMPLE <br /> MEASUREMENTI <br /> PERMIT ,~ .,; .: - .. ~ 1-1EF' ~ '' r ,_ ` • - r,ic~ <br /> REQUIREMENT r :30DA AVG UA I L <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - .: _ `; ::• ~• I t n t •,,,. ~ _, <br /> REQUIREMENT ':?I'~ i ::':; I L'r I'! %: i•1 ~ ~ ; <br /> SAMPLE <br />_.t~,_ MEASUREMENT <br />`''4 PERMIT is#a~•,+:, #:f.r', ts•:-c . _. ~_ t _ _ <br /> REQUIREMENT ; _-UA ~' .''_- Dri I L Y t 7X <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT -~ ~ i :~~ t r-' _.. <br /> REQUIREMENT 3i:': ' ~ ;',~.';~ '•-i;~, i L •', <br /> SAMPLE <br />_. MEASUREMENT <br /> PERMIT .. ,- _ •. <br /> <br />REQUIREMENT <br />- <br />-~ ~ •~ u <br />UA I1_'' - <br />: r <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ;E ~ ~f -, .. -:; , ._ ... ~ . L . . ~ <br /> REQUIREMENT ,_,,a '',VG ;~ -,: . <br />NAMElfITLE PRINCIPAL EXECUTIVE OFFICER I certify under pemalt~ of law that Ihi. d~a•untrm end all attuchmenh were TELEPHONE DATE <br /> prepared under m> direction ur open i+ion in accordance with u +~+tem desiKned -- - - --- --- ~ . <br />- <br /> <br />-~ -- ~--~ ~- to aswrr that yuulified perwnttel prnperl~ yuther and es aluate the infurmulion <br />• ~ <br />, ._ suhmiued. HA ed on ms inyuin d the prrvm ur pentut+ who manage thr y+tem. ..- = <br />~I ~ <br /> <br />~ ur throe p•rwm+dirtt-tl~ re+ponsihle for patha•rinK the information. the information - <br />- ; ~.. <br />~ y <br />~ ~' ~ nt <br />wnd sY~m <br />kte <br />h <br />t <br />th <br />h <br />v <br />wted <br />c <br />d 6 <br />li <br />f <br />tr <br />s <br />itt <br />d i <br />r <br />k 1 ~ ~ / <br />'~ ' ~ ' - ~-; ~ ' -Y .-x- <br /> p <br />. <br />o <br />m~ <br />m. <br />g <br />an <br />r <br />e <br />. <br />ue. a <br />w <br />a <br />.u <br />m <br />c <br />s, <br />o <br />e <br />e $IGNATURE OF PRINCIPAL EXECUTIVE - - <br /> I am uwarr that there are sif;nificunt penalties ror suhmiltink tutu infarrnntion. AREA <br /> sibilits or fin <br />and im <br />ri.unment fur knowin{t+inlation+ <br />t <br />di <br />th <br />u <br />i OFFICER OR AUTHORIZED AGENT NUMBER YEAR MO DAY <br />TYPED OR PRINTED . <br />p <br />nr <br />u <br />ny <br />e p <br />s <br />e DE <br />~ COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />~~ <br />I EPA Form 3320.1 (Rev. 3199) Previous editions may tx~ used. Qfl 1 ' :.• ~ ~ ='~T1S:tJ :i'•~-plift ~bTt11. <br />