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PERMITTEE NAME/ADDRESS +Inclttde Faeilir• ~ame/lncarinn if Ikfferenr+ NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDESJ <br />NAME - DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS '~~ I. <br />PERMIT NUMBER DISCHARGE NUMBER <br />FACILITY , ;_ ~~i ;•I i i•.j _ ~- _ ~-.:-;;i~:(_+L+ ; MONITORING PERIOD <br />LOCATION '<)/t~if: ` ~ Q ~ ~ ; YEAR MO DAY YEAR MO DAY <br />FROM TO <br />URGE V. "AT7ER~~1P~, GEN. MC• <br />Form Approved. <br />~ ~ ~~~ pMB No. 2040-0004 <br />csUn~ -rv> <br />F - FIT~A~ FR€ <br />POPlP. ? t-=;c-HI'G Y~ Ct•tA,,is-: -_ 13 L~?~, <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 .'. <br />' ' • • <br />~:+~i,. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT -- ~ _ , ~- <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT .. .. _ <br /> <br />REQUIREMENT ,i - <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT .. _ - , .. .. .. , ~ - ~ -= -- <br /> REQUIREMENT ~ i`l:r - ••I; ~r•; i :-r <br /> SAMPLE <br /> MEASUREMENT <br />~ _ <br /> PERMIT ~- -~• ... _.. - <br />: <br /> REQUIREMENT ' ' E-: ; <br />,I ~ : ti <br /> SAMPLE _ <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br />a ` % <br />l <br /> SAMPLE <br /> MEASUREMENT `~ <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I arrta. "ndcr Ixnath of law Ihat Ihia d~KUmrm and nll :nWChmrnh wrrr <br />l _ ~ <br />~ TELEPHONE DATE <br /> <br />1 ~ u M ~~ _,' ~^~I <br />1 ` ' \ '~ preparrA undrr m~ dirrclinn nr auprnicNro in nn•nrdnncr with a sfx:rm draignn <br />to x.wrr Ibat yuulifird prru:nnel prnprtir Rn~hrr and ra ~luu~r thr information <br />h <br />h <br />b <br />t ~ <br />~,~ _ <br />~ • <br />~ <br />/ ~ / <br /> r prrwm ur prnun. w <br />w mrnugr: <br />rm, <br />wbmlttrd. H+.rd nn m~ inyidn of ~ <br />e .cs ;, <br />~ ~- ~ ~1 ,q~.~,, <br />~ <br />' ' ~ <br />v <br />' _ _ <br />. ur thus pa•nnrt, dinrU~ r~ Iwnaibk far gathering for information, thr inGarmatarn f <br />~ <br />- /~/~ ~ - <br />~ <br />i - <br />l <br />i- '. i i <br />t ~ ~ <br />~'~ ' ~ ~ <br />,ubmimd ia. ~..:hr M•st of ma Am:wh•dgr and helirf.:n~r. uccurulc. and compklr. <br /> <br />SIGNATURE OF PRINCIPAL EXECUTIVE ~ <br />/ i J ~-~ J <br />_. <br />,~ + <br />/ ~. <br />~~ <br />'- <br />TYPED OR PRINTED 1 am awarr phut ilwro an~,i¢nirirant prnalties for whmittinR falu information, <br />including :he po~aiMlita of fine and impriwnmcm for knowing aiolatiom. OFFICER OR AUTHORIZED AGENT AREA <br />D NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />,~ <br />EPA Form 3320-t (Rev. 3/99) Previous editions may be used <br />