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PERMITTEE NAME/ADDRESS rlncludr I'ariGh >,umellocotinn if Ihffrrenq <br />NAME J" <br />ADDRESS '~tT <br />`i0 f30i••)1 E t . <br />'..z~ cQ aj <br />FACILITY ~ !: t ~ ::. ` :` .- , - .. _:: ; T <br />LOCATION ; I ~} ~; D ~ j <br />_ LY €= R i T <L 1=fi : '°;~P4~a0ER <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 />(5Ui3R f"tH t <br />F - F I P•~tfilL <br />~)rL• i P DivO # 1 TO IV P't <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 /> gNALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT tt:: - . , r _., ._i, .- -. . ! ~.. <br /> REQUIREMENT .~~'~' ' ." ~ . <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT 1 i'•l:: i i. ;1. " ' , <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 />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I rrrtiq Hoerr prrmtr~ •.1 ~:n. shut thiv d~~cumem and rll ulluchnn•nQ wrm TELEPHONE DATE <br /> preparrd undrr ml I i ur nr vuprntsiun in ua~ordanc with n p.tem designed <br />us <br />- onm•I <br />rn <br />erl <br />vuluutr tAe infurmuGnn <br />t <br />rr th <br />ti6 1 <br />lh <br />r <br />d <br />l ~ <br />, <br />I <br />AA <br />. ..-. - p <br />p <br />~ 1}p <br />o <br />vu <br />u <br />yur <br />1 <br />r <br />en <br />e <br />Rusrd on r piir~ ~d thr Irrrvem or perswn <br />who murtnkr Ihr srvtem. <br />.u6mitird ~ <br />_ /. <br />K <br />>~T(/ ' . V I ~.. h. ~ <br />/ '") ~ ~l ~~ <br />•~ <br /> . <br />. <br />or Ih~nr person. dFrr tl gmsiAk for >:utttrring ihv inf rrmat4m, the infurmalhxr 1 <br />~ <br />~ <br />~ ~,. X <br />' I I ~/ <br />~ u <br />r M <br />wkd <br />ner <br />a <br />d <br />l <br />te <br />I <br />d b <br />li <br />f <br /> <br />t <br />%,i . t no <br />~r ro <br />. true. •cru <br />• <br />n <br />c <br />mp <br />r <br />. <br />sobmilled iv, to the L.~•r ~~ <br />m <br />e <br />r <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br /> I um uwun• Ihul Ihen .,n ~~t;nJcont prmeticv fur vubmiuin~ falvr infotmwli[m. <br />I f <br />i <br />wi <br />rid <br />ti <br />d i <br />t <br />h OFFICER OR AUTHORRED AGENT AREA <br />NUMBER YEAR <br />MQ <br />DAY <br />TYPED OR PRINTED irer an <br />mpr <br />n>; <br />u <br />sonmen <br />for <br />no <br />includink thr pocdbd,r, ,~ <br />ons' COD <br />GC7MMtN15 ANU tJ(YLAIVAl1UN Uh AfVT VIVLAIIVIVJ Jnererence nrr auactuncrns nl:rr~ <br />~4-Hft F <br />G'Phis is 8 4- aft form. PAGE ~OF <br />EPA Form 3320.1 (Rev. 3199) Previous editions may be used. P <br />