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PERMITTEE NAME/ADDRESS rlnrlade Fruilifv :Yamr/Lueation if 1HJferenrl <br />NAME _ _ _ <br />ADDRESS - • - ' ~.~ ~'•i i . , , ._. <br />'"~ UTI~`/~rr('' fiitiIlV ST;4EE'; r~ /r^p <br />-~ t fYti'(i 1.1 tJ•L.i R1LrVC <br />FACILITY '~E.r~iCiT~ GF1PdY01~1 I"91Iti1>= <br />LOCATION ~ j 3r.! CQ ['3 ~ ~q ; <br />_~II~, F^1rJDlfiltilOtVr hliNF i'IAIL•AGF14 <br />NATFONAL POLLUTANT DISCFIARGE ELIMINATION SYSTEM NPDES) <br />DISCHARGE MONITORING REPORT (D R) <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 />LAMS=: <br />N(~TF• Rwarl Inctrllr•tinnc hofnrw' n nlwtinn thic tnrrn <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO• FREQUENCY SAMPLE <br /> OF <br /> <br />AVERAGE <br />MAXIMUM <br />UNITS <br />MINIMUM <br />AVERAGE <br />MAXIMUM <br />UNITS EX ANALYSIS TYPE <br /> SAMPLE ' <br /> MEASUREMENT <br /> PERMIT ~ - ... .... ., _ _ <br /> REQUIREMENT "` '9,=,• `• 1 `~, ,., <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT _.:/ _- <br /> REOUIREMENT ~ <br />i=`'~ • ~ ~ ;•: „" <br /> SAMPLE <br /> MEASUREMENT ^ I ~`•~~ <br />- <br /> PERMIT :, ~ .. ,. ,~ <br /> REQUIREMENT "' ° hi <br /> SAMPLE ' <br /> MEASUREMENT ~ <br /> PERMIT - - ~ - _ - _ . . <br /> REQUIREMENT ::~-:•0,' , . ~ i'I! ;' c i <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ '° - ' <br /> REQUIREMENT ~~,-~ i-~ :' . •' ~: '_ ~ ti `•t Y, Irfila.(; I <br /> SAMPLE <br /> MEASUREMENT <br /> .. - <br /> PERMIT 1 , . .. <br /> REQUIREMENT - f"'i=+'\' i7FNT <br /> SAMPLE <br /> MEASUREMENT <br /> .. <br />. - .. , ,. <br />- <br /> PERMIT •. _ . ,- <br /> REQUIREMENT - f)r~~, i'-.~ !:~~ ". ~'±. <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I rrrlif) under prnulq •.f law thin Ihia drw-uma•m and all atwchmrnte were <br />d <br />d ~ TELEPHONE DATE <br /> <br />• prepurr <br />un <br />rr m. direction or .ulk rvi.i•,n in narnldanee with a .term de~i~tted / ~ /' <br />y <br />~.- ~ . <br />;f. ~~ _- In u..urr that yuallfnd Iw•nnnna•I pn•prri~ kaUaer and ra nlaale the ink•rmatlrwl <br />/ <br />' <br />/ <br /> <br />-1 - <br />' wbmitta•A. liaxd on m. inyuir7 of the per.on nr per«m. who manaKr thr yeem, <br />or ihrne I,crwn. dirndl) recpon.ihle tar /;alhrring the information. thr inGxmotiun i /J <br />~ <br />::/ -f ~ ' ~ ~2~~ ~ ~~ - <br />~~ --• <br />~' ~ ~ ~` 1 / - ~` / <br />~• `' <br />~^ ~ <br /> <br />7 <br />N ,. ~-{,• - <br />/ <br />` <br />r .ubmiltrtl is, to lhr ba: t of m~ knawledXe umJ br•lirf. trnr, arcuratr, and cnmplelr. <br />! <br />~ <br />/ <br />/ <br />~f - <br />~ I :rm awarr thin them are.iKnifK•aN <br />enultM. for submittin <br />ful <br />• inf <br />ti SIGNATURE OF PRINCIPAL EXECUTIVE <br />TYPED OR PRINTED p <br />g <br />u <br />orma <br />nn. <br />includin>; the Iwxcihilit~ n( tint anal imprisonment for Mnowin~ riolali,uls. OFFICER OR AUTHORIZED AGENT AREDE NUMBER YEAR MO DAY <br />e`rl~~~~CiJTC Ai•Ifl CVDI ANATIlIN elC ANV Vlell ATIAhIC /O..l..~........ .. rr ..w.... t.~~_•_ <br />_ _-____---_ _ _____ -- ---_.-_ a ~-- _-___..... _..__ .._. _~ <br />5$, ~ ~:.)ru °: P1HN6r;R1)::•SE L I M i TS 4\i I I_ L Tjr 7 <br />EPA Form 3320.1 (Rev. 3~) Previous editions may be used <br />J Itt. ~~ :: -1-Is.irt h~t~~ - -PAGE OF <br />