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PERMITTEE NAME/ADDRESS itnctwleFrxdiry.~4rmi:~Larntrorr((l+Jfrrenp <br />NAME <br />' x.14 ~;~_~~,~~. ~ r•~+:.. <br />ADDRESS - ,'i i~' <br />,., ~ _ <br />FACILITY <br />LOCATION <br />;j '~ <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) Form Approved. <br />DISCHARGE MONITORING REPORT (DMR) OMB No. 20x0-0004 <br />PERMIT NUMBER DISCHARGE NUMBER _ c * r`!,4t_. r?13l. <br />MONITORING PERIOD 1rlA~H <br />YEAR MO DAY YEAR MO DAY <br />FROM TO ,k~ <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION Np. FREQUENCY SAMPLE <br /> <br />~ OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT :- ,... • . ~.- , <br />.. - '-.j f ~~ r~ 1~ ~'- -'. ~ REQUTAEMENT ~ ~~. <br /> SAMPLE <br />_ MEASUREMENT <br /> <br />PERMIT <br />~ <br />_ <br />i i :7.. <br />.. . <br />1 ~ - ~~1..L~ REQUIREMENT ~"_, - F:.- I•i: "•' <br /> SAMPLE - - <br /> MEASUREMENT <br /> PERMIT ~,: r. •- ; - ., '~ ~ ; _ . _:, r .;: - <br />_ _ - ~ ' REQUIREMENT . <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT a' _ <br />-_ 1 REQUIREMENT <br /> SAMPLE ~ <br /> MEASUREMENT <br /> PERMIT _ !~I .•; : i <br />;_ ~ REQUIREMENT - <br /> SAMPLE <br />T?-;~~1 : i~_:%r~~ i'~.f'W I FL..:'''.; MEASUREMENT <br />• PERMIT .- .- - ' ... . ~ .. .i'J <br />c~ f- ~:~ . -, - REQUIREMENT .. .. ~ -c ~, <br />• SAMPLE <br /> MEASUREMENT <br /> PERMIT - ~ - = i._I'= ? - _ - <br /> REQUIREMENT - . <br />NAMErTITLE PRINCIPAL EXECUTIVE OFFICER I Cefilt\ under pctwl[4 Ut IllK' th:1t Ihls d+h'!lInC111 :Intl :III :4(t:ILfit:1e11I~ '.+dli <br />h <br />l <br />d <br />d <br />d <br />di <br />'i <br />t TELEPHONE DATE <br /> .u~n m nCC.+r <br />an.c :<u <br />a sarnl . <br />prepare <br />un <br />er my <br />rection or supen <br />cvgm- <br />S~~ - • , , ~ r _ / ,e to as:urc chat ymliticd ~xrsonnel profxrly gather and e.aluate ilia iniLmrauon ~__, <br /> submined. Basal on my inywry of the ry.•non or pennns who manage the system. ~~~ ~_~- ~.,~ ~- .r <br /> or those persons dlr¢tlc responslblc tier gatbenng the infunnation, the Infonnmion - l~~X~~ <br /> h <br />d b <br />f <br />d <br />~~ ~ ~ -, whnuimd 19, to the <br />2•,t I~f mp know ledee an <br />elie <br />, true" accurate, an <br />rnmp{ete. <br />.i <br />~ i <br />m+:c <br />enalties far submltnn <br />falu intnrmatlon <br />: <br />h <br />r <br />nt SIGNATURE OF PRINCIPAL EXECUTIVE !` %• ~ ~ i s .? <br />/ ~ ~ ~ :- 'i <br /> <br />/ <br />TYPED OR PRINTED . <br />. <br />. <br />-- <br />: <br />_ <br />a <br />p <br />g <br />. <br />,. i ! _ ' ~ r '- i i n, ;,nd Impnsonrtunt for knowing vrolati.ms OFFICER OR AUTHORIZED AGENT AREA <br />CODE NUMBER YEAR MO <br />DAY <br />GVMMtrv I ~ Arvu rxrLArvs~l wrv ur fUVT vwL~al Ivrva Inererence an anacnmenrs nere~ <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. <br />~CIllS fS~3 ~~~an fOtTil. PAGE <br />