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PEgMITTEE NAME/ADDRESS Ilrklude FaciGrr Aamdloration iJpr%jrnntl NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />NAME - .. DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS _. ~-_. _ -'. <br />~~ E C}W Y E ? t' PERMIT NUMBER DISCHARGE NUMBER <br />'~1~ <br />FAaI_m ;OR CRiE1t I_~ •- _ , ~ MONITORING PERIOD <br />LOCATION .. ? r; r- YEAR MO DAY YEAR MO DAY <br />•= rJ S 1'' FROM TO <br />Form Approved. <br />UMB No. 2040-0004 <br />( ~t <br />F <br />rtLlt <br />x <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY SAMPLE <br />OF <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <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 /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br />' <br /> SAMPLE • <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAMEJTITLE PRINCIPAL EXECUTIVE OFFICER I certif. wakrpenalh ~•na.. Ilutthhd~aumenland;dlattachmenhwrrr <br />i <br />itl <br />d <br />i <br />d TELEPHONE DATE <br /> prepared wafer ma dirertiun ..r auprnia <br />lm in acronfunrr w <br />l u aiatem <br />es <br />Knt <br />~ J ~ <br />, [.., ~ <br />~ Y~ "'~ to nawrr Thal qualified pchonnd properly 4athrr and ea alualc tlx informaUnn <br /> <br />~ \ / <br />L <br />- '~ <br />`~~ <br />^ <br />" <br />^- --wbmittrai. Board .m m. inyuin' of thr prrwn or pa•nutn who mana>Zr Ihr y <br />atrm, ; <br />r (~ <br />. <br />~Y - <br />~ <br />~ ~ <br />! <br />n ~ <br />~ <br />~ / <br />/ ~ <br /> ur thn.m prnc.rt4 dirrell) rrapmaibk fnr pthcriny thr mfortnati~m. thr infnrmatkm "- ~ ~ ~: <br />~ <br />% • <br />` ~. <br />~ <br /> <br />•± ~ ~ ~ ~ ~ auhmimd ic, to ILe Iw. t of m7 knowlyd~e and Mlirr, tnm, urcurmr. and rnmplrtn /$IGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED OR PRINTED I um :reure thuf there err afRnifkam prnaltira La vd!aniUUlp /:J•c infonnaliua. <br />inrhalinK Iho pos ihJiry of tint and imprhunmru; G.r Ln„win;; .i,.i,u.n,,. <br />OFFlCER OR AUTHORIZED AGENT <br />AREA NUMBER YEAR MO <br />COD <br />DAY <br /> <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />.~ t'FtE <br />aZMF.D. FXEMf'? <br />EPA Form 3320-1 (Rev. 3/99) Previous ed11ior15 may be used. Thiti iv tt -1-~tRft tt)rr11. PAGE OF <br />