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oved. <br />PERMITTEE NAME/ADDRESS (Include F'a•tlity.\a,u, l.auwm :l IkJl~nnr, NATIONAL PCLLUTAIIT DISCHARGE ELIW!NATION SYSTE;A (NPDES) ','~ :.. 2040-Qi)v <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS ik {", :. '.. ~:C r. •JLM(SIV <br />). E ~' . PERMIT NUMBER DISCHARGE NUMBER ~ -• F I n'IA~ <br />_ .. , <br />)REPt~ MONITORING PERIOD <br />FACILITY t R M ? '•; . YEAR MO DAY YEAR MO DAY ~{ <br />LOCATION _ Din( '., i : ~ FROM TO <br />:Oft G 1r '+i . 1~ h T f ER SON r GF.i~ NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO• FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> arlaLVSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE -- <br /> MEASUREMENT <br /> PERMIT ... .- , ~ ,... ;.- . ,. ~ , ., ~ • _ . <br /> REQUIREMENT ~ .. .i ~-:~ Z Pl{_}fr1 MUhI t ~ •' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT :r c .:. ...- _ - . r. _. <br /> REQUIREMENT - <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT -: a .. _ ~~ <br /> REQUIREMENT ' <br /> SAMPLE <br />' MEASUREMENT <br /> PERMIT _ <br /> REQUIREMENT ~ _ <br />' tt ~ ' '~ <br /> SAMPLE <br />,: MEASUREMENT <br />r• PERMIT ... ,.. ., .. <br /> REQUIREMENT ~ ~~ .:,-r; <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I rertir, antler prnauy nrmw thm thin d~w•umrnt and all atwehmrnls were <br />~-- TELEPHONE DATE <br /> pnpand under m) direction nr +uprrricirm in accordance with..cstrm designed <br />l <br />h <br />o <br />I <br />f <br />i , c <br />~ ~ / <br />t <br />.~i C~ ^S~" i . ,•I LLT: , I ~ <br />l i nn <br />to aaaure that yualificd pcrvmnrl proper <br />y gul <br />rr and r. aluute f <br />r <br />n <br />urmnt ~ <br />/ <br />~ <br /> +ubmiltad. Ruud rm mr fnyuir~ of lhr lw•rann ,~r prrvma who nwnu>;c the +~+trm. ~ ` <br />- <br />~ _ <br />I~G i_ 1 ~ - ~ <br />C t3 or th„sr prrvm+direclll rrapon+iMr Gu gatlKring the infurmutxm. the information ~~ `-" <br />- <br />~~ ,O_ ~ ~"~_ Y ~] ~Q (', ~ ; <br />_ <br />_ nd co <br />itt <br />th <br />t <br />. k <br />wl <br />d tu•li <br />f <br />t <br />c <br />r t <br />det <br />s <br />b <br />d i <br />M• <br />d <br />d 1! ` <br /> +, to <br />~ <br />m <br />no <br />Kc an <br />r <br />, <br />rot, ar <br />u <br />r, a <br />ny <br />a <br />su <br />m <br />e <br />e <br />.+ <br />e IGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED OR PRINTED I am aware th.d tlnn~ arc .ignificant penaltia> fur cubmiLLing falu information. <br />imludint; mr tnsihilin .,t fine and imprisonment for knowing +i~dulions. <br />OFFlCER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments Here) it <br />~RECIP EVENT SUB.IECT TO BURDEN <br />EPA Form 3320-1 (Rev. 3/99j Previous ec <br />