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PERMITTEE NAME/ADDRESS r/nrlade F'aiWf A'amdlocation iJIHJfarnU <br />NAME - i • .. , <br />ADDRESS _.I . I'i : ~ , <br />%r c i'~ <br />i. `' t'314 ~ ~ <br />FACILITY ~ ;. r ; ;', t•• .i I'r~ <br />LOCATION C !~ L~ I ~ ~~ <br />L_P.i~t:'~ ~.;~:,_>~, t~i:Pl;v i'fANAOE#? <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. 2040-0604 <br /> <br />~y <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ, FREQUENCY SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ,-s:-: ;'i ~i• I ~ - - _ <br /> ;REQUIREMENT ? i••!`=i'i f"IAk <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 crrtifs under penalq of lua thnl this dwwnent anJ all attachments sstre <br />ed <br />ul <br />r <br />s Ai <br />i <br />-ti <br />i <br />i <br />i <br />d <br />h <br />0.• <br />d <br />i <br />d <br />~~ TELEPHONE DATE <br /> prepar <br />w <br />m <br />rn <br />on or atperv <br />s <br />un <br />n accor <br />ance w <br />a s)c <br />r <br />t <br />m <br />rs <br />gor -- <br />~ _ <br /> <br />~ to wsure that qualified prnnnnel prnprrt~ Ppl hrr~nd esulualr Ihr information <br />._~~'~ submitted. Rasi'rt un m~ inquiry ,d the person nr persons oho nurnage the s~strm. I ~ ~ ~ ! <br />`} <br />' ~~ <br />~ or Ih~nc prn~m, dirtw tls req>„miblr for gathering the informutlon. the infortna6on "r~ _ <br /> <br />' wbmHtrd ls, to the best or m7 Isnuw ledge and tmlief, true, an~urnte, and wmplete. ~,( <br />. <br />; ? • 7 'x~>'t '" __ ' <br />! <br />~ 1 nm Haute Ihut there net significant Ixnaltirs for suhmiuing faisr infornwtlon SIGNATURE OF PRINCIPAL EXECUTIVE J <br />' ~ <br />TYPED OR PRINT@6 - <br />Including Iht pwsibilit~ u! ftnrnnd impri+~mmcnt Gar knowing siolations, OFFICER OR AUTHORIZED AGENT AREA NUMBER YEAR MQ DAY <br />t„•VMHICI\ 1 J Nlvv enrl_rst~n l wn yr rst~ r vtvt_n l lvlva Int:rt:rrnct: an vetoer«rrt:rvts Here/ <br />+}( <br />EPA Form 3320-1 (Rev. 3.'99) Previous editions may Ce used. <br />This is a •~-part firm. PAGE OF <br />