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PERMITTEE NAME/ADDRESS ~lndu[kFrxi(ib•.~bnrciLncarimti/Di,QdrrnU <br />NAME <br />ADDRESS - <br />FACILITY .; ~. is i : : 'i i . °. ~ <br />LOCATION; - EL•Y ,_ f, <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPOES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Fcrm Approved. <br />OMB No. 2040-0004 <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY <br />OF SAMPLE <br /> ~ TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMU <br />M UNITS <br /> ~ J ~ ~j <br />,7 C~ ~) l/7'I 1~ -• <~ , <br /> MEASUREMENT J <br /> PERMIT _ - .. ~ i`:•._. C!.`:c.'.. <br />-.L !_' REQUIREMENT .Ism - .. 1.,:.r.. ~ ;•i <br /> SAMPLE <br />~ ~ -~ <br />~ <br />% <br />C ' ,~ <br />' <br />% <br />: ~ ~~ <br />~ <br />r MEASUREMENT . l. , <br />> _ :::. PERMIT - <br />?- T- r i ;, ; ~ I ~ REQUIREMENT _ - <br /> <br /> MEASUREMENT <br /> PERMIT r. ~. ;, , ., _. ,, r, -: <br /> REQUIREMENT <br /> SAMPLE <br />G <br />` - <br /><-' ~ + <br />C' ~ ~' <br />~ ~~' <br />~~' ~. <br /> MEASUREMENT . v= <br />~ ~ ' <br /> PERMIT .- ~ - ~ + <br /> REQUIREMENT 3Fi I L_ Y ~' <br /> SAMPLE <br />~ ~ <br />~'~ '' ~ <br />•'"'' J ~- + <br />~"~ <br /> MEASUREMENT <br /> PERMIT - ' q -`I!•~`3 <br />c_x., . - - _ REQUIREMENT r l•;a;-~ ~.._ r,i <br /> SAMPLE ' <br />t ~~r- l = •.; .I MEASUREMENT iJ Di • j ~t~ ~ t'i v •U ?Z l Cc v ~' _ ~ig~: f~ <br /> PERMIT - -- r.:.i (~ --xk'f - ( ly';.~F .~ ~! '~ •=°i l <br />:.: r• C •_ i REQUIREMENT M~N7`i <br /> SAMPLE ~~ • 11 // <br />~~ ~~ ~ " <br />% ~ ' <br />~ 1~ <br />~ <br />~ <br />~ <br />(•~ <br />i ` I ` <br />: MEASUREMENT JT <br />r C-/L1~ - i2~- <br />~ <br />- PERMIT - _ :fir. r.~rtf-' { I~EF'..?~-r i ~. ,- fir-:. ~{ <br /> REQUIREMENT _. ; i. •' <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certif} under penalty of In~r that this drx;un~ •m and all ~+wchmem+ werr TELEPHONE DATE <br /> prepared under my Jtrecnnn nr supervrsron m accorJance with a sy~.tem drstgned <br />~r i'. i 1_.._ <br />~ ~ c.~"' ~ ` :~ T.~~~ -•- `~: to as>urr thil yuahtied pcrwnna•I properly gather and e~~aluate the infi~muunn <br />submin d. Baud an my Inyutry of the pcr:con or pcnons who rnanaue the tiyRem. ___ <br />~ ~~~> - <br />~ ~ <br />~' -. <br /> or thrnc persons directly r-spunsiblc (or ganc~ring the infonnarion, the infurtnution ~ <br />' <br />~'~'' - <br />_ sttbmind is, to the best atlny knowledge anJ 6ehd, true, accarere, and ~omplcte' SIGNATURE OF PRINCIPAL EXECUTIVE ,. ~ ~ r j ' L ~ <br />`" I am aware that there are sgmficam penalocs fnr submioing false information' <br />L <br />l <br />i <br />i OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR MO DAY <br />TYPED OR PRINTED tnre <br />ng ~ <br />anons <br />+ncltufine the M~sstbility of tine mrd imprisonment fnr <br />„ CODE . <br />COMMENTS ANU tXF'LANAIIUN Vr ArvT <br />Ine/crcncc an aua~.nnrenw rrcr cl <br />. IR ~~CI <br />4: l~Mf~l T <br />PAGE OF <br />EPA Form 3320.1 (Rev. 3/99) Previous editiors may tie used. ~,. ,r,L~ ? ; ~ j ;T}l15 15 a ~-~drt fOI1Tl. <br />