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PERMITTEE NAME,~ADDRESS NncluJr F'acilin• A'mne/Lorolin+r IjDi/jerrnU <br />NAME <br />ADDRESS <br />;UEL.Y <br />FACILITY ~. t< fi lli <br />LOCATION ~ . • • ~ ~ `• Y <br /> <br />NATIONAL POLLUTANT DISCIiARGE 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 />Form Approved. <br />OMB No. 2040-0004 <br />x~ <br />i <br />NOTE: Read Instructions before comoletinq 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 />~,~ 1 •-, MEASUREMENT <br /> PERMIT ,t ":. ,. ~ , •.r :r . <br />i ~i`j`! - -'? =1''.`..i teal-t_I: 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 /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER ~ -~-ntn under penahy n( tax that this document and all attachmen~c wcrc <br />d <br />i <br />i <br />d <br />d <br />~ TELEPHONE DATE <br /> <br />~ trccnon ur sutxn <br />ston <br />ance Hnh a system <br />prepared under my <br />n arctx <br />c <br />s~encd <br />~~- <br />- <br />/t ~~/~s f•' ? ~ ! <br />t <br />S to assure that yw~lified personnel pmperh- y_,uther and esaluate the inL~rmauun <br />' <br />' <br />. <br />~ submitted Based un my myurq ul the perscm or persons who manage the systctn, ,fie- <br />~_` ~~~ <br /> ur Uxssr persons dua-tly rasponsiMe for gaihertng the mfomtanon, the urti~nnabnn - -- ~ -- <br />~/ ~ -~ <br />~~ ~'~'- submttt d t+, to the hest of my know lalge and txhef: we. aauratr, ant! complete. <br />I am awaro that Atcrr <br />uc ,i <br />nrticem <br />enalties for suhmrttrn <br />false infonnanon SIGNATURE OF RINCIPAL EXECUTIVE - - ~ <br />~•'! ~' " / 7 1~ <br />TYPE OR PRINTED . <br />g <br />, <br />p <br />g <br />i <br />i <br />l i <br />ti <br />di <br />~ <br />i <br />t <br />L <br />~ <br />i <br />t f <br />k <br />i <br />i <br />l OFFICER OR AUTHORIZED AGENT AREA NUMBER YEAR MO D <br /> ic .• <br />n c <br />nn> <br />mc <br />u <br />n <br />r <br />tr r <br />a <br />c <br />m: am <br />m r <br />sonmen <br />ur <br />now <br />o <br />:r <br />t• r, ,> p 8 <br />CODE AY <br />COMMENTS AND EXPLANATION Vr ANr viV~.vtl was t-rererence au anacnmenrs Here/ <br />,R p: <br />- ,~ ~ ,~-. <br />EPA Form 3320-7 (Rev. 3!991 Previous editions may be used. <br />OF <br />