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PERMITTEE NAME/ADDRESS drulrrde Fortlifi Nmna~Locorinn rjOtgcrrnU <br />NAME <br />ADDRESS _;F'ADI <br />FACILITY - <br />LOCATION , <br />:, i~ ~ 1 c, 4H <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 />ri <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, FREDUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE ' <br /> MEASUREMENT <br /> PERMIT <I- `~ . ~ _ yJ) [ i:• /" r~2 .a 1r <br /> REQUIREMENT !•;•~, ~ MLll+i I~F-I <br /> SAMPLE - <br /> MEASUREMENT <br /> PERMIT - ' i.i <br />. ~ ;.; ; ~:,` ;. ; REQUIREMENT <br />• ..- i SAMPLE , _ ! <br /> MEASUREMENT <br /> PERMIT ar , - -: ~ ,, _ <br />- - ,~ <br />- ±_; REQUIREMENT <br />` <br /> <br />t. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ' <br />t t ~' REQUIREMENT ';TF; <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - !-;.~ ~ 'r?t'',? TT; i <br />" `_ ' ',J[ ~ - ~.;.5 V':,. REQUIREMENT ~ __ , <br />;••!?~,zt f j '( CIF SAMPLE <br />ARV I I`tr_=~'. P!ENT PLI;f•!'t MEASUREMENT <br />. ''~ .' '"J PERMIT : ~ .-t~xt~ _ ;r-, r~__ .}t, <br />r r~ ~ ,:.: ~~ t~• ~, REQUIREMENT '••!'.... <br /> SAMPLE ' <br />`I MEASUREMENT <br /> PERMIT - -~- . .., r •. :~~,:~- RL=-Pr:.~F't ; c,:' <br /> REQUIREMENT ° ~~ s ;. - <br />NAME/TITLE PRINCIPAL IXECUTIVE OFFICER I -emn wader Ixnalrc o(law that tfis d.~ ument and all attachnxnts were <br />d <br />d <br />~i <br />d <br />h <br />d <br />i TELEPHONE DATE <br />w prcparal tin <br />er my <br />trccaoo er supen <br />tuw m accor <br />a s}stem <br />ance wit <br />es <br />gned <br />_,.~• ` <br />S~ e' // ~~~`~ ~/~ <br />'f ~~ to acsurr that yualiticd 1+erx.nncl properly gather and e~aluutc the infumuttnn ~, _.~--, <br />' <br />~ auhmitted. Based un my mywn of the Persnn nr perm. whn tTwnagc the .} qcm. , i _ <br />~ ~ - <br />~ <br />~~ _ i or those prrums dnec[ly respoostble lirt gathering the intiatnauon. the in(otmau~m '/ r <br />' <br />~ / ~.-~/% submittrd s, w the beet of my knowiedgc and belief. true. accuram, and complc[r SIGNATURE OF PRINCIPAL EXECUTIVE - -=•i `~ : <br />' ` <br />5- l --' S <br /> 1 am aware that thtre arr st <br />tuticam <br />rnalttes fnr suhmitun <br />Ldx iniomuu„n _ ~ <br />, <br /> <br />P <br />R P <br />D . <br />g <br />p <br />g <br />di <br />hih <br />d <br />f <br />i OFFICER OR AUTHORIZED AGENT ~ AREA <br />NUMBER <br />YEAR <br />ED <br />RINTE <br />TY ng the possi <br />inclu <br />ty of fine an <br />imprisonment <br />or know <br />ng ~rolauon, _ _ _ ; CODE- _ MO DAY <br />COMMENTS AND EXPLANATION OF ANY vIOLAI IONS (rrererence all attacroments Here) <br />EPA Form 3320-1 (Rev. 399) Pre~4ous editions may be used. <br />