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PERMITTEE NAME/ADDRESS ilndude Furilih' .~umdLoration r% UiffrreMt <br />NAME <br />ADDRESS <br />FACILITY ~ _ _ . i'; .... _ . _ -- .- <br />LOCATION ~ r. a- r.~ L LI ~ ~. i`3~`. <br />r ;• r i-t t] F; i= t~ LAMA' `~h; i~1AE~i~GER <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 ND, 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 /> 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 />NAMElfITLE PRINCIPAL EXECUTIVE OFFICER I aenif) under penaln of law mm mi: d.KUmem and au mwrhment+ Mere TELEPHONE DATE <br />preparrd under mr din+~lian nr +uprrvi+iun in :nc.udance wish a .~+Icm de+iyrmd <br />In a+wre rhal yualifiavl prr~onnel pruprrh galhrr and ca aluah• the in(ormmiar <br />+uhmnrcd. Bawd an m} inyuin of the prr.on or tarnun. whn manaXr thr +y Nrm. __ <br />f <br />i <br />h <br />i <br />~ ~ <br />e in <br />urnwt <br />un <br />ur Ihu+r prrsnn+ Ainrll~ re.lmn+ihle fnr Kalhrnn4 the in(ormal <br />un, t <br />I <br />d <br />~l <br />ki i <br />H <br />irf. true. a.rurale. an <br />a.mp <br />.uhmiUral i+. L. the ire+t of nn Anawledkr• and <br />n $IGNAT~RE OF PRINCIPAL EXECUTIVE ~ <br /> I am swan that there arr +igni~a ani tk naltic+ for whmiulae faly infurmWion, <br />m for km~wi <br />d n <br />i <br />m <br />aidaU~ <br />+ <br />h <br />ih <br />l <br />d f <br />OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MQ <br />DAY <br />TYPED OR PRINTED npr <br />+on <br />nµ <br />ua <br />. <br />Im9uainK I <br />ih . <br />ine an <br />e <br />r la^+ <br />i <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />EPA Form 3320-1 IRr'~' r~e.:v~s ~~•ra.:^s. ~ .. I~ht~ i. a 1-I'arl f~~ini. <br />