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PERMITTEE NAMElADDRESS rlnrfudr f'acilih ,~'antr!lncation iJlhf/arnfl <br />NAME `' •~L;`J~ L.LC <br />ADDRESS ~ -- <br />T; - - <br />FACILITY _,: ~ . t .- , - ~: <br />LOCATION ~ t~ i:1 t3 I ~ c' 4 <br />a Atdr F WAiSF, M T PdF MANAGER <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 />~ ~ a . •n.. <br />5R°aMTIVE TRMO TRID TO <br />NOTE: Read Instructions before competing 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 /> MEASUREMENTS <br /> PERMIT - .~ i~EPQf2T REPOT?T ~~'~ • ~ ..'1;. <br /> REQUIREMENT t~.P+a Ftb't= DAIL'~l fY Y !"IQRR~';- <br />' SAMPLE <br />,; MEASUREMENT <br /> PERMIT ~ ~ r. -: ='. SPQR T - - - <br /> REQUIREMENT :3a~+~ ; ;`Jb . <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT n.c-}-;::. -- i-ZEPQf3T ~:~. _ <br /> REQUIREMENT -`-'•1_'+~; F;`.'t? ~,, - , <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT r- ~ : ~ ~ ~ '- , . c <br /> REQUIREMENT ?CiD~ u:'1 ~ t ~"' ' ` <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 crrlih undrr prnaln of law that this documrnt a~ :dl auarhments wrre TELEPHONE DATE <br />prrpnred undrr m) din~rtion or auprn~ision in acrunlancr with u .stem drsiRntd <br />to assure that yuali~rd peoonnel properly Rather and crrlunle IM• information - _ - -'"'- -. <br />whmitl d. Hauvl on m~ inyu{n of the penon or per.nn who manatee thr stem, I - <br />~~ <br />_ <br />-~ -' - - or tbo.r prt+ua, direrth re,lwmihk fur katlx~rink thr infornwtino, thr mformution - - , <br />..-. I <br />ti ;~ ~i <br />li <br />t <br />l <br />lrl <br />d i <br />h <br />I <br />f <br />k <br />l <br />d <br />d h <br />f <br />d <br />L <br />ouw <br />rue, urrura <br />r, an <br />rnmp <br />r. . <br />,uhmiur <br />s, to t <br />r <br />kst o <br />mr <br />y <br />>;e an <br />r <br />r <br />. <br />: <br />I j + SIGNATURE OF PRINCIPAL EXECUTIVE <br />i <br />f <br />h <br />i <br />t <br />i <br />f <br />1 um awrre that there arr significant prnull <br />or su <br />miu <br />nR <br />utu <br />n <br />s.. <br />urmauun. AREA <br />TYPED OR PRINTE iniudin~ the pussihllity of fim~ and imprisonment for -nowinR ~i~datiom. OFFICER OR AUTHORIZED AGENT D NUMBER YEAR MQ DAY <br />COMMENTS ANU tRF'LANA I Wrv VF ArvY VIl7LA I IVIVJ (rreference an aaacnmenfs Here! <br />EPA Form 3320.1 (Rev. 3/99) Previous editions may be used. ~-~ ?~.' /~'~T~IItS-IS ~t 4-pitl't iOfll]. PAGE OF <br />