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PERMITTEE NAMElADDRESS ilntlndc f'arilirr .\'amr/Lurarian if Diffirrnn <br />NAME <br />ADDRESS i=~ <br />FACILITY ~.y~ r~ ~ r;~ . <br />LOCATION f_.F' ~%.h ~. ~ ~i7-"r~- <br />'~V)= F.~f.f-tr ,'~ ENV ~NuIN1=cE~ <br />NATfONAI POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDESJ <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCNARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved. <br />OMB No 2040.0004 <br />( `al1T3R .1C i <br />F -- FItVAL <br />SVf~I'~f-,%F ^nUf~t <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ, <br /> <br />EX FREQUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ANALYSIS <br /> SAMPLE <br />MEASUREMENT / ~ 1 <br />'t <br />YIS~AL <br /> PERMIT ..~ --~ ., ~ _ .. _, ~~L <br /> REQUIREMENT r-1"~ 1 ` <br /> <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 /> <br />EXECUTIVE OFFICER <br />NAMElTITLE PRINCIPAL I arrtiF ender rrnaltt wf Lew that thi. d~a~umenl and all ath~chmrnt+ were <br />1 ~ ~ i- <br />~ / <br />_ <br />TELEPHONE <br />DATE <br />. <br />-~, <br />- ~ ~ •~~ preparrd undrr m+ dtmvun nr wprni+iun in uccurd:mce with a y+tan de+iKned <br />to n++ure that yualiliad p runnel prnpcrh Kalhrr and rvaluole the infurmulinn <br />wbmatttl. If.rud nn m~ inyuir+ of the pcnun ur prrv>n+ whn manaKr the +rvcm. <br />..r thu+e pennn+ dtntiYly re+prm+ihle fnr Kathrriny, the infnrmabnn, the infnrmatlun ~-__~ <br />~ <br />/ <br />~r/I,// <br />.~, : ,_ -- ~~~~ <br />~. ~ - ~ <br /> <br /> <br />~ <br /> <br /> <br />. <br />_ ~ - +ubmm d is, to tha hest ~~f mr knmaiedge and hrlief, tnir, aca orate, and cnm{drtr. <br />SIGNATURE OF PRINCIPAL EXECUTIVE - ~ (/ ~f ~~ ~ •. ~~ / <br />-' / ~ ~'- i,~ <br /> <br />TYPED OR PRINTED I am aware that there pn~ .iKnirirmt pemdtin fur+uhmittinq fat+c inf~~rmatiuo, <br />inrludinK the pn+ibilUt ~d tint oral impriwnmenl (or MnowinK ~inlatinns. OFFICER OR AUTHORIZED AGENT AREA <br />E NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Heterence a!! attacnmenrs nere~ <br />I EFa Form 3320-t (Rev. 3/99) Previous editioru rrtay be used. 'I'hjy'jgt a ~-~8T'f fOml. PAGE AF <br />