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PERMITTEE NAMEIADDRESS rLalwk F~riliN.Name.'L,r:rr,n i(D~rc.rU NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDE$) <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />FACILITY <br />LOCATION YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form 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 /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE ' <br /> MEASUREMENT <br /> PERMIT . -.. <br />1. J <br />•~ . .. <br />~lA4f <br />- .. I l~~"t•: _ t ,'_ tJ REQUIREMENT •, 1 ~• C1y~ - i. I'~11~~'d i I i <br /> SAMPLE <br />_., ,• MEASUREMENT <br /> PERMIT . t - ...~-'^..R T I'~FF'.... , -; 1-. •f rt~.NP <br />- j t 1~ REQUIREMENT '.:r: ' 1 /.~`.' ' ! <br /> SAMPLE <br />.- , _ MEASUREMENT <br />. PERMIT a ~ ., ~ '. . `~ ~~I Li <br />. ~ ,~ r'? f ii ; _, REQUIREMENT `~.,5,-: ' <br /> SAMPLE <br />t _,; :,c~i_ MEASUREMENT <br />' PERMIT ~ -sr-~'.t'- ~ •Lt I _ ~ .:i'-.'~i. <br />)-L t.l}'_t•t r _ 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 centt} under penalty of law that thls (kxuntent and all uttachmcnu wCre <br />d <br />" <br />1 TELEPHONE DATE <br /> <br />~ prepared LLndL`f Iny <br />lrecn(ln nr 1UpeRItilUn In eiiUrdanCC N <br />11 <br />1 a cylCnl dCCtearcd <br />ld <br />l <br />h <br />l <br />l <br />' <br />l <br />"~ <br />l ~ <br />- <br />~i~l L '~~'~} ~ = ` to tssurc t <br />at yua <br />icd pers(mnc <br />pmpcr <br />gat <br />lcr and eva <br />uate the mlunnauon <br />} ~~! <br />-'- <br /> submith~. Based on my inymn~ of the txr•,un or persons who manage the system, _ _ <br />~~ <br /> or ihux p(:rwns dlreetly re+p.raciblc fur gathenng the inf.~rmauon. the informotion ~ ~ - - ~' -' =' <br />~ <br />J <br />_ <br />JJ <br />~ <br />, subminai is <br />to the bes[ of m <br />knnwied <br />e and belief <br />trot <br />accurate <br />and enmplcre t " <br />' ~. `~ <br />f ` ~ <br />; ., . <br />~- ~ . <br />. <br />, <br />p <br />g <br />, <br />. <br />th <br />t th <br />t <br />ln <br />l <br />t <br />I <br />t <br />6 <br />h <br />itti <br />f <br />t SIGNATURE OF PRINCIPAL EXECUTIVE ~ - r ~; <br />~ - ~ r <br /> <br />'OR PRINTED <br />PE am awnre <br />ere arc ;iCm <br />~r.m <br />(kna <br />e, <br />x .u <br />orma <br />ion. <br />a <br />m <br />ng <br />a <br />x m <br />l <br />h <br />ihih <br />r ti <br />. <br />d <br />i <br />d <br />k OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br />TY <br />,p mc t <br />e pocs <br />r..~ <br />ne .^i~t nnpn,.nunrn: ! <br />a <br />nowme el~ <br />nt <br />^n. <br />mc <br />u CODE <br />COMMENTS AND EXPLANAI IUN Vr qnr vluLal wlvs (r,rererence au arracnments nere~ <br />IMF L.1 N <br />EPA Form 3320.1 (Rav. 3;99) Previous editions may be used. T}HS tS.b ~ art fort. PAGE OF <br />"G13G:'-~ 'P <br />