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PERMITTEE NAME/ADDRESS Unrludr F"xiluy Namdlorutiun iJlhfJaenJ1 <br />NAME ..%~{'li: ~,,,: <br />ADDRESS ~' i,_:•'• LOADO\' 1 <br />40 IIGWIE rtOHLa <br />:;;za <br />FACILITY `i ~~R ' ~R~' ' ' ". ~ T` <br />LOCATION ,; j A ~ ~~ <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 />M I NOF <br />i 5UL3` <br />~ - I' <br /> <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION <br />NO. FREQUENCY <br />of <br />SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ - <br /> <br />REQUIREMENT <br />~ <br />iYi t I'•~ ; .., „~, <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT :.. ... ... -- <br /> REQUIREMENT ~" ~" ' ~ ~ ! <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~~ <br />, <br /> REQUIREMENT ~ '~. ~ <br /> SAMPLE <br /> MEASUREMENT <br /> <br />PERMIT _ , <br />_. <br />~- <br /> REQUIREMENT ~ <br /> SAMPLE <br />MEASUREMENT <br /> PERMIT <br /> <br />REQUIREMENT _ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - T = - - ,. . <br /> REQUIREMENT ~ <br />.. ~• ~ • <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~r . ~ ~ .. _ _ <br /> REQUIREMENT ~ ~ - - ~` •'' <br /> <br />NAMElTITLE PRINCIPAL EXECUTIVE OFFICER I crrtiry undrr Iw u:dtr or Inca that ibis daaumrnt xnd xll xlmchmrma were TELEPHONE DATE <br /> prrpxrrd under ma direction or wIx•niaion in xu~nrdance with a ay atevn dr.ignad / <br />JL aa-I '~ ~~ , ~~ la xcaurr Ihm qun611bd pcr.onnel properly guthrr and roxltwtr the inrornmtiMl , ~, ,/ <br />fry ~ •'- <br />f~1 <br />~ <br />\ <br />"~'/ <br />' <br />- auhmitLLd. Na.rA ••n ms inquiry o(the prr.on nr prr.ons who mnnaRe lM• caatem. ~ <br />/ <br />. <br />rL` <br />~ <br />~ _ ~ <br />~ ' ^ ~~ <br />~ ~ <br />~ <br />` <br />l or Ih:w• per.on. dirlrlle rnpm.ihlr 1'or Qalhrrin>< the infurmutinn. tha• information ' ~ 7 <br />lL~I/. ,., ~~ r-~ aubmiunl ia. to the (test of nn AnowledKe aml Ixtirf. wr. ereura[e. and complrtr. ~ SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED OR PRINTED I um aware that thcrte rre.iRnirkunt prnaltirc for athmiUing fuly infonnnti,aa. <br />inrludink tha• p,n,il~ity of fine and impri amment for lannwinst aiolxtium. OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLa1wNS (Heterence an arracnmenrs nere~ <br />2~-HF{ F'E <br />EPA Form 3320-~ (Rev. 3/99) Previous edAlons may be used <br />'I'bis is a d-parr form. PACE <br />