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f PERMITTEE NAME,ADDRESS ilnc•luJeFw•tflrj Narroc%Laariiin ijDi/Je.rnrl <br />I NAME <br />ADDRESS <br />FACILITY <br />LOCATION. . ,• -- <br />I F•.. ~.. ,-- . <br />(`+ (- r~ Z fj c~. <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 />MINOR <br />~I Ili? <br />Form Approved. <br />OMB No. 204D-0004 <br />~~ <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ;- a: ~A% <br /> REQUIREMENT <br />,_ - <br /> SAMPLE - ~-- <br /> MEASUREMENT <br /> PERMIT a. -: , ~ ; <br />- ':~ ~,;..lJ REQUIREMENT <br />_ SAMPLE <br />_ _•., :, '~[:) MEASUREMENT <br /> PERMIT t, , - , .- . <br />• ~;+ • ~ REQUIREMENT <br /> SAMPLE <br />-( ~ MEASUREMENT <br /> PERMIT .. a: <br />- REQUIREMENT ~- ,. ; [_''r '•• i <br />• SAMPLE - - <br />= ~ ~ ~~ ?+ ~ ~ <br />L _ ~ - - MEASUREMENT <br />- PERMIT '~~="=: - ;,t./,.I~~-r ra~t'('RT ~;!_.~ - <br />L lJi= F•: ~ ,.'.a; •- REQUIREMENT ', ~, <br />" ' ; ~ "i SAMPLE ~ ' <br />• ~~..C~~;`lRPIL+; = MEASUREMENT <br /> PERMIT ~: r-t ~ s i:it~ ~ tYF~~t'' ,..- _. ~ ,- -'H~3 <br />- ;~ '~.::' REQUIREMENT >, .--,~ - ~- • . • <br /> SAMPLE <br />_ - .~ • . MEASUREMENT <br /> PERMIT _r.r„'~ r °F1--;o -I- -~:t <br /> REQUIREMENT - ,- ! `. <br />NAMErfITLE PRINCIPAL EXECUTIVE OFFICER I certify under penalty of law that th,s dckurnrnt and all atta.hmcnt. „,-r._ <br />l <br />d <br />di <br />~i <br />i <br />d <br />d <br />i <br />h TELEPHONE DATE <br /> <br />- - prpare, <br />un <br />er my <br />recnon or supcn <br />s3nn <br />n acn r <br />a s) stem <br />estgncd <br />ance w <br />t <br />5~~,/j/ `~~~ ~ . ,: in assure that yualificd Ixrsonncl properly gather and ccaluatc the mh,mtnnon -~_.-- - ~" ~' , <br />~-7 <br />" <br /> sutmtined. Base+1 on my mgtnry of the person or persons whu rtw.wgc the system. •-~_ <br />-- /~~~ _ <br />- ~ <br /> or those persons directly responsible fur gathcnng the mlormxtion, the informanon ~ <br />~jp , ~ • submitted is, to the hest nt my knmvledge and bchcl'. true, aceun,tr. and conmlrt° <br />I am aware t}tat there are stgnifirant penaltisw fnr sulrmutin <br />t:d.; cr,v <br />~~:,••i <br />n SIGNATURE OF PRINCIPAL EXECUTIVE "~_ = 'L ~ r l ~ <br /> <br />TYPE OR PRINTED , <br />g <br />: <br />itn;ludmg the possiMlitp u(tinc and tmpnwnmcrtl for knuwtnt ~.:, r: ~r OFFICER OR AUTHORIZED AGENT AREA <br />CODE NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />EPA Form 3320-1 (Rev. 3r99) Previous editions may be used. 0OQ ~ 7 Tf11S iS 3 ~-dart form. <br />