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PERMITTEE NAMElADDRESS (lnrfwda Fa'ililr .~'amr/Lorariun iJ IliQerrnr, <br />NAME <br />ADDRESS <br />i, <br />FACILm ' <br />LOCATION : /,y <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 />M3 <br />(~ <br />F,•aTi A~~OrwGd. <br />Or.1B r3o : uao-oooa <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION <br />NO. <br /> <br />EX FREQUENCY <br /> <br />of <br />ANALYSIS <br />SAMPLE <br /> <br />TYPE <br /> <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />MEASUREMENT i ,- ,-~, ~ <br />~'' I~~ ~(~ <br /> PERMIT <br />REQUIREMENT <br />~•~• ~~ •~ <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT - <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ' <br /> REQUIREMENT ,, <br /> SAMPLE <br /> MEASUREMENT <br /> <br />PERMIT <br />REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I ccrtifi weler pc•null) of Ine thal this Atwumrn/ an<I all mmchntrn~s weer ,-- -- TELEPHONE <br />pmpan~d umlrr ms direcln.n ..r supers i.ion in ua~ordatx~r with u system tlesfpned / __ I <br />~'. ~ - .Lj-: ~<. to anwrr Ihul yualifitd per„•,nu•1 properly pylher and rsrluatr the inlutmatitat -- - - - -- . <br />- - _ - ~ --}~ -' suhmilted. Rased on my Ihy,rii ~ of the person or pa•notu wlw munair the ss stem. ~"' <br />• or Ih, nr {k non. dirnth n ~tu,n,tblr for Ka1M•rittQ the inrurmulion. Ihr in/urmutinn "- _ t 7 <br />" stthmillal is, to lhr barl rd u • AnowledKc and hrlir(. Into. accurate, and eompklr. ~ i - -' ~~ ~' ` J <br /> <br />~ .--- <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />` <br />-~~ - <br />~ DATE <br /> <br /> <br />r <br /> <br />~- ~~ ~•/ ~`\'_ <br />~ -i <br />- - t <br />~- I um awmr that thrrt are .i,nifi. ant g, folsc information. <br />penulticx for suhmillin AREA <br /> <br />TYPED OR PRINTED <br />hKhtaine the po,.lhaity or 1,~,, uttd imprisonment for Anowin~ slnlatiotts. OFFICER OR AUTHORIZED AGENT NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANAIwn ur anY VIVLM IIVI`IJ Inert:rencr nu aua~nnrtana rrcr c~ <br />-- - - - _ f'qf;~ --OF -- <br />EPA Form 3320-1 (Rev 3.99) Pr~•vious zJ!-_ ~~lt~ ~. n nali ~~,r,i~ <br />