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PERMITTEE NAME/ADDRESS Nnrludr Facilih~ Name/linwnan ijlhjJrrrntl <br />NAME <br />ADDRESS <br />C <br />Fac1uTY ! t NE <br />LOCATION ~tEh-~.~ C' <br />~iRGL V F'AT'('ER501Ut i`9I; <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, <br /> <br />EX FREQUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - . •_:,. _. .... - "... _ - _ <br /> REQUIREMENT r-~ 1 ~~ ~ rr,! ,:,i .•: ~ .' MS:rI _ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~' <br /> REQUIREMENT ~~' • <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT _ .... _- ._ _ ...... - - - . ; ,.. _ .. -- <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />" <br /> PERMIT , :: ... .. , - <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT :.: I + _- . ,. .... .. ,- _ - . <br /> REQUIREMENT ` ; ~`% . ' - {.; _;; ; ;-i <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />~ ~' { <br />}•f <br /> REQUIREMENT ' <br />1 <br /> SAMPLE <br /> <br />MEASUREMENT _ <br /> PERMIT - <br /> REQUIREMENT ~~ <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I eertir, ender pen:dh of law that thi+d:K•ununl and all auachmrntx wart <br />r <br />d <br />nd <br />r n <br />diredi <br />• <br />d <br />i <br />i <br />i <br />ith <br />d <br />` TELEPHONE DATE <br /> <br />~ p <br />epare <br />u <br />e <br />p <br />un ur wp <br />n <br />aut <br />n accur <br />attcr w <br />+ <br />a .)Wem <br />r+iRnrvl / <br />~~ <br />~' `-` <br />~ <br />D ~ ~+ ~ ^^ ~ w ~~ ~t <br />.7~\ l~ - l j ~/ In a..nrr that yualified prrs~mnai proprrl~ gatbar end r. aluata• the inrtxmatiun <br />.ubmiuad. Ra+ed an mi inyuin nr lhr pet~a~n ur perv~n. who nwna>;e the srctrm. _ <br />~ - <br />. %hl~-'` JJ- __ <br />P ~ ~' f. ~, ~ ~ ~ ~ e <br />! <br /> nr tho.e prnon. din~all~ raYp..nciblr (..r gathrring the information. the information i -~~: l j ? Y <br />`' <br />(..~ x <br />;,! ~•' <br />+ubmit~ d i., lu the be+t ur m~ knawledl;c and hrlirr, true. as aerate, and campkta•. <br />j ,;: 7 ~.r 1' ~~ <br />! ~ ~ /~ - 2 <br />~ ! J <br />_ -. <br />~ <br />tom/ \ I I am awet•r That thrrr ara• +itni0aam penahiec fur +ubmittinR fal.r information SIGNATURE OF PRINCIPAL EXECUTIVE ! <br />TYPED OR PRINTED . <br />including the po+.ibility of fine and impri.onmenl ha knowinti; violations. OFFICER OR AUTHORIZED AGENT CRpE NUMBER YEAR MO DAY <br />t,vmmerv I ~ rlw cnr~rtt~h t wn yr r~t~ r vtvt_fa t tvtvJ Int:rerence an areacnmenrs nere~ <br />EPA Form 3320-t (Rev. 3/99) Previous editions may be used. _w,e ~- ~I~f11~ IS n ~-Part films. <br />