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PERMITTEE NAMElADDRESS tlnr(ndr Farilitr :~`amr/lueatiun i~lhJJerrnU <br />NAME <br />j ADDRESS <br />FACILITY <br />LOCATION <br />;: LI L• i 1 v` ..~ <br />`lfitt 1~0!" R <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO OAY YEAR MO DAY <br />FROM TO <br />Form Approved <br />OMB No 204p-pppt <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION N~, <br /> <br />EX FREQUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> <br />MEASUREMENT <br />K ~ ~ _ <br />~ <br />I 1 <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />` ~ ~ <br />~ i <br /> MEASUREMENT ~ ~ ~~ ' <br /> PERMIT ' <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />~ <br /> MEASUREMENT - ~ <br /> PERMIT <br /> REQUIREMENT - <br /> SAMPLE <br />~ <br /> MEASUREMENT '--~ t <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE , <br /> MEASUREMENT 'L, <br /> PERMIT • <br /> REQUIREMENT <br /> SAMPLE ` <br /> MEASUREMENT ~ <br /> PERMIT <br /> REQUIREMENT <br />NAMElfITLE PRINCIPAL EXECUTIVE OFFICER l ..at~t~ imdrr prnan) ..t to++ mgt thl+d:a-untrnt and :Al atrarhnrem+ wen' <br />~ <br />d <br />d <br />i <br />A TELEPHONE DATE <br /> prcpund under m+ Aim ti:m nr +a{w•r. isiun in wa <br />or <br />ann• with a +y+trm <br />r+ <br />knr <br /> to a+sun• than yuulifiid {N•rwnnrl pmprrh Kulhrr anJ c+aluote the information <br /> whmittrd. Iixvd ou m~ inyuin of the yrnnn nr {x•rum+who mnnuge ihc.~+k•m. <br /> ur thine peraon+ dirrcth rcwpnn+ilAc for y!athcrin~ nc~ information. the informwion ' -~ ~ , <br /> cuhmiUtd i+, bt tlk• tw-t of ma knnwhdgr and belief, tnte, uecurulr. anA complete. <br />i <br />f <br />f <br />h <br />i <br />f <br />l SIGNATURE OF PRINCIPAL EXECUTIVE ~ ~ <br />~ <br /> <br />TYPED OR PRINTED +e <br />unnwion. <br />I mn uwurr Thar there are +ignif~cant penalrHr <br />nr w <br />mnt <br />n~ <br />a <br />n <br />indudin~ rhr {an+ibllir. of fine anA impri.onmem for f+nowing .iolntion+. OFF ER OR AUTHORIZED AGENT A Fi E A <br />~ n NUMBER <br />~() E ,. <br />YEAR <br />MQ <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />EPA Form 3320-1 (Rev. 3'98) Previous editioru may be used. `'`~~~R~ <br />