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Form Approved. <br />PERMITTEE NAME/ADDRESS parir4irWryN.w/Loerrarl/DIQGrenr) <br />NAME ~C)~,1I~ 1~5Qll~~5°5 L_. 'ri`iYT~:O <br />ADDRESS~~`~~?G ~)~. G I~~I~~ <br />t~~t~s~il~a raj ~~~2~ <br />FACILITY T3~Iin1 ~ E I'~3C3. ~ Irl I SiS~ <br />LOCATNNJF~~ACII~I I ~ ~~ S ~ ~~~} <br />~TTI~!: 1~3~LL.?MSS`'3 ~. i3~~4~ ,.~R. , t"tZiV~ I'°iC,'~2 <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM //NPDESI ~ pM8 No. 2040-0004 <br />DISCHARGE MONITORING REPORT /DMRI ~.) ~ ~~[)~ <br />CC)QfJ~'Y`~`~'76 i?4? ~ f 5LI~r r°iH> <br />PERMIT NUMBER DISCHARGE NUMBER ~` --~ ~ I ~A~ OEI--T+~+ <br />7?'~i~#-iG i3~ ~~3 7C1 t~Ul'~11# ~ aC3~ R I;J~~3 <br />MONITORING PERIOD <br />Y MO D Y Y MO DAY <br />FROM ~- TO ~. #~`il- i~lC) l) T SCI-3~115~~ E ~_ I ~:~## <br />NOTE: R~~d Imhucdofa b~fw~ cornpNtinp this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, <br /> <br />EX FREDUENCr <br />OF SAMPLE <br /> <br />TYPE <br /> ANALrNS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS. <br />~°~ :E~S~ SAMPLE ##~##•r~ { q.tt) ###•~•## ##~tit~~•# •IY•#•:~iE-#•rt <br />~ IryLj~~, MEASUREMENT <br />~~~1b;'s ~ (7 #~ ~~~~>PERMIT #if•.~.x..,r•~- ~~b: sN ~ .w~~~ ~r~~#a~~~~~ r##~•~3~- ~#~~-~~ ##•i~ ~ ~~° ~~Ih.'_'c .1.~ ; <br />~~~'L.U~f~IT ~F~Q~S EIc~L.t3` R~nUIR~MENY Z f~i5"i" I~~~ ~CI~#~ -~•~~•~~rt <br /> SAMPLE ~ ~ J C~ ~%~ <br /> <br />MEASUREMENT <br />Cc ~ <br />c/ - i <br /> PERMIT' - <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> ';PERMIT i <br /> <br /> <br />. REilUiREMENT'; <br />_._ <br />............................. <br />___ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />__. <br /> SAMPLE <br /> MEASUREMENT <br /> !PERMIT I <br /> REL3UIREMEN*<_ <br />,::::: <br /> SAMPLE <br /> MEASUREMENT <br /> ::?'PERMIT <br /> ai~QUia~M~N'r' <br />........................... <br />............................... <br /> SAMPLE <br /> MEASUREMENT <br /> f~ERMIT ''' <br /> REQUIREMENT>~ <br />NAME/'TITLE PRINCIPAL EXECUTIVE OFFICER r anuy u er pena ry o law that ihb document and au attaehmenu were <br />prepared under my direction or wperrMon In ateordantt wllh ^ syatem desl[ned TELEPHON E DATE <br /> to asmre that quaHOed personnel properly plher and evaluate the Information <br />/ <br />~ <br /> suemitted. 6aaed on my Inquiry or the person or penoro who mana[e the system, /r <br />/ 7 f~ <br />[ <br /> or lhox penoro directy respordbk for ptherln[ the Information, the Information v ~// 'r /~ /~ ~/^ ' / <br />~/G'G/P ~'-" ~ ~~ <br />~ <br />~ wAmltted Is, to the brit of my knowkd[e and be8ef, tree, acavnte. and eompkte. <br />810NATURE OF Pi11NgPAl EXECl1TIVE 97U (rte/• ~ ~~ ~J(~ (~ ~ ~ ~/•C <br />C/ ~ <br />/ I am awaR that then aR al[nI11Unt penal8a for fuhmltdn[ hbe Inrormaton. <br />TYPED OR PRINTED Includin[ the poaalbluty or ene and Imprtaonment for knowin[ rldaUoro. OFFICER OR AUTHORIZED AGENT CODE NUMEIER YEAR MO DAY <br />COMMENTS AND.EXPLANATION OF ANY VIOLATIONS IR~l~r~nc~ s// ~tt~chm~nts h~r~l <br />S~ i Tl_~[=ta?L.C. S(~LsTJ~ !.._~f°°i"rT ~F'{`'L.I~ac' (~l~IL.`t~ ~~ ~~1Q'1€d, 2~il~d Pr"21="CZ~ ~~~:6~iT ~',.s' CL..(~?'6"iL~. TI^ GL_~It~i ~§'~R~~#~~3 13~ I/<lQCL"ir <br />T~~ ~:~ I~C~t~! L_IP°iETS bJLI~.~ i~tQT B~ t~i@'I~'i..~~&] TO ~2EPClI•TIWI~ i1~'~UI~~~1L.i~11'~-SEA I. ~. ~, laf' ~•-S I`Q~ ~UE#~9~a'~ 1~1=" PRgQt~ <br />~, ~. .,.. .... _ ~.. ... A ~_ , .... ~, <br />_ _ _ ~r r. ~.r a.rt-t - Tr4W r -.~ a PAGE OF <br />EPA Form 3320-1 (Rev.•3/99) Previous editions may be u ed. _ ~ ~~+~~;~,, f $ I v'v~~ t~.'IVt'34-~a~rt~l~rm. c <br />