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PERMITTEE NAMEiADDRESS rlnrhrJr Fut,rlip :VumcLncmimr tjD~ennll <br />NAME <br />. - . ~ ~ _. <br />ADDRESS <br />FACILITY <br />~ LOCATION <br />co a z ~~f <br />MAtVA•:~~ F' <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDE$) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Fcrm Approved. <br />oMe No. 2oaaoooa <br />X <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 .-: •a <br /> MEASUREMENT <br /> PERMIT •• - `:i •x -t-r c.n>t ~ ilCr/ tL3Ur"i <br />~; ~ REQUIREMENT `1QNTH <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 I eerttfy undar malty of law that this document and all artac•hments wrre <br />l <br />d <br />i <br />d <br />i <br />h <br />d TELEPHONE DATE <br />preparn <br />er my dtrccunn or supen <br />ston to accor <br />ance w <br />n system deergttc <br />tin <br />t <br />l <br />h <br />~~ to acsurc [hut yualtti ~1 Ixr,onncl prnlxrly gather and e.a <br />uaee e <br />e inf~rmmir,n <br />~~. ~.GFi- <br />` <br />! <br />aubmmad- Baud m my rnyurry of the pi~un or Percotu who manage 4rc system. ^ <br />~r~ ~ <br />° <br />~l -err <br />` <br />nr those pcrcuru drrc tly rcspansstblc for pith nn~ the information the mfonrtntiou '~ - ~" <br />' <br />C- ~ : -~, wbmittad tc to the I ;t of my ln.~wieilc ,n 1 Ixli •t tn~r ac.unt .and tornplerc <br />! ~ • • I <br />r~.nn <br />m <br />!I: <br />t th <br />r <br />- <br />r <br />m ! <br />! <br />, <br />h <br />+ <br />- _ <br />_ <br />SIGNATURE OF PRINCIPAL EXECUTIVE -1 :: 7 <br />~ _ <br />~, .7 <br />. <br />awrur <br />+ <br />r <br />c .,gn <br />~ r <br />: <br />n <br />r <br />. <br />a <br />r <br />r <br />. <br />TYPED R PRINTED <br />di <br />i f OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO <br />ng ti., p~•:;•h!hr.:r <br />ina :.~~ n:p ,. i .. .• . tir c,_ t •!> <br />inclu DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference alr attachments here) <br />-. =. c z F <br />A. 1 <br />PAGE OF <br />EPA Form 3320-1 (Rev. 3/99) Previous edRions may oe used. -;; ~~ } } ~ ; {';;~~t13 1521 4,part form. <br />