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PERMITTEE NAMElADDRESS 1/"rfade PariGry ,~'amr/ltxation i/IhfJrraw NATIONAL POLLUTANT DfSCHARGE ELIMINATION SYSTEM ((NPDES) <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS J i _ ._ <br />~Qh ~ PERMIT NUMBER DISCHARGE NUMBER <br />FACILITY i•iOF? Y ZUf•.i i'1 a LJ L • } MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />LOCATION _ A ~: r,} :- FROM TO <br />t d,iUCt= WATlF. t'1TNF hlAt+3A>.=,~ <br />Form Approved. <br />oMB No. zoaaooaa <br />;~: ~ ;-; - r~rl= D~ <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ, FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT] <br /> <br />PERMIT ~ <br />Q '~".; ,. - -,,.. <br />-. - <br />i ~ ~. <br /> REQUIREMENT ~ >.',~G r';i <br /> SAMPLE - <br /> MEASUREMENT <br /> PERMIT - : a..,, ., ~ . r= . ~ a r, <br /> REQUIREMENT : to T t- 'Y '': ' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT is _ ~_, _ ~~ ,t r~~: <br /> REQUIREMENT DF~ii;_Y .-~ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ,. :. . -r ~• ,}~ #k~ # ~1 •` r...r _„ t _. <br /> REQUIREMENT 't~ CH r'~`,IG Dr+ 1 L (' <br /> SAMPLE <br />-:;_'v:._ MEASUREMENT <br />r- PERMIT #•?s•a:#:; ~ sr , <br /> REQUIREMENT 3 7DA AV{; DF+ I L. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT .r :r + - - _. <br /> REQUIREMENT ~= ` ' ~ ' <br /> SAMPLE <br />I <br /> MEASUREMENT <br /> <br /> REQUIREMENT _;CiDA A ,' _~ `_ ~ ~ i ; ~ I.. <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certih °nder Ixmalt~ or law that thi+dorumtm and ~dl mtn~hm~~m+»~r~ --%----~.__ <br />arrJ under m. dins~tion ur +upan i+inn in occardance w ith a system de+iFned <br />re TELEPHONE DATE <br /> p <br />p <br />to rnsure that yualifird personnel grope rh gathrr and cralurtr tla: infurmauon ~ ~ <br />~ <br />-".--' -' _ whmitted. dead on nn inyuin or Ore pesos or larson+ who manrtte the system. 1 J ~ <br />or lh.nt prrsom direcOy rr+pmsihle for Ratherin~ the information. the information ~ qq <br />l <br />- <br />~~~ <br />~ <br />~ submiR dn, to the he..+t of nn Lnowlydge and laak•f. Irvr, uccurute, and complete. <br />~ 'T <br />~ <br />SIGNATURE OF PRINCIPAL EXECUTIVE ~ ` ~ .~ ... <br />' <br />- I am aware thm them arr.ignirk~ant pmaltir+ rur+uhmittint; fal+e intortnation• <br /> <br />TYPED OR PRIPITED OFFICER OR AUTHORIZED AGENT AREA <br />inaudin¢ thr gn+ihiliq or fine anal imprisonment fur Anuwin~ .iohdion._ D NUMBER YEAR MQ DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Heterence au arracnmenrs Here! <br />EPA Forrn 3320.1 (Rev. 3/99) Previous edtioru may be <br />This i. a ~-p<tCC ftxm. <br />~i ~ <br />