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PERMITTEE NAME/ADDRESSllnclwle FacBitr:~'amr/larufiun iJ(NJJ'nrnrr NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS <br />-. .- " ; s= PERMIT NUMBER DISCHARGE NUMBER <br />FACILITY MONITORING PERIOD <br />LOCATION YEAR MO DAY YEAR MO DAY <br />FROM TO <br />MI <br />i~ <br />Farm Approved. <br />pMB No 2040-0004 <br />~. <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ, FREQUENCY <br />OF <br />EX SAMPLE <br /> <br />TYPE <br /> gNALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT (~ /~~ t ~ ~ `' ;,E <br /> PERMIT r ~i•; ;. - ~ .:. t- >, - - s -~ ' _ <br /> REQUIREMENT : ; i i'' ; ' -. <br /> SAMPLE <br /> MEASUREMENT ~ ! Iq ,.•~ ` ; -~~ ` K't ^I`_- <br /> PERMIT <br /> REQUIREMENT i ~; ! '1~~ <br /> SAMPLE <br /> MEASUREMENT j^j ~A (~r ! j i~ ~ ~~~ <br /> PERMIT - a _ , r <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT (.i ~ ~~ ` , ~ ~! ` C ;1 Z L~ <br /> PERMIT ~ - ~'~, -~ ~t- • '. r~=~ _, ; ~. - - <br /> REQUIREMENT - - <br /> SAMPLE <br /> MEASUREMENT t~ r/A j '~ ht ` <br />C ate( <br /> >, . ; <br /> PERMIT ..~ti• z - . nt- - s ~ , ., i ~: + -- ~ .. <br /> REQUIREMENT ~ : (=r' " - ~~!`•' '•' - - <br /> SAMPLE ' <br /> MEASUREMENT i~'~~ ~,~ [jlJ(_I '~~~~ <br /> PERMIT ~Iv - -.r ': •::.c ~: ~ - y ~- r: -: - <br /> REQUIREMENT <br /> ~ <br /> SAMPLE --' <br /> MEASUREMENT r•.i ~:1 FJ' 1 Lj I ~_,C t~ ~' ~ <br /> PERMIT : - .. _ _ - <br /> REQUIREMENT " - ' -~ ` ~~ - <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I ~.•rti(! undrr Ix•twuyof ~nw lhm thi+d~avtnrnt anJ •rll atWrhmenl+ wrrr <br />n• <br />an•d nnd <br />rtion nr w <br />enision in <br />curdan <br />with <br />r <br />di <br />o <br />drei <br />ed ~-~ TELEPHONE DATE <br />I <br />.` <br />e` I <br />~ t <br />_ ^ <br />~~,r <br />~ ~ <br />`L \ ~ <br />` p <br />p <br />p <br />r <br />m~ <br />t?r <br />ac <br />re <br />a n <br />rm <br />gn <br />to auure That yuuli0ad p+n~.nnrl prnlxrl~ t:athor unJ r.alualr thr information ~ <br />1 ~ <br />1 <br />- <br />~ <br />v <br />v ' <br />i <br />. <br />\ <br />G <br />~ <br />" submitted. Bard on m~ mywn n( the IRMm nr IICMm+ who manaµr thr sl+lrm, - <br /> or th:~se penons dirMl~ to+pmsil><~ for yythering the in(nrmatMn, the information <br />, yy <br />~ <br />~ ~ U ~ ~ - i- <br />"~- cubmittrd i+. to lhr best ~~f m. knowledge and Imhef. True, accurrle, and rumph•te. <br />1 am awarr Ihut ther <br />si <br />nificant <br />enalti <br />submittin <br />(ul <br />x infor <br />tio <br />s fu <br />i - <br />SIGNATURE OF PRINCIPAL EXECUTIVE , ' , ~.) (,- ;J <br />_ ~- <br />- - ` Ci ~~ i lip I ~,,. 1 <br />TYPED OR PRINTED p <br />g <br />e <br />rc <br />g <br />e <br />r <br />_ <br />ma <br />n, <br />tm'luding the p~h ibiljO of fine and imprisonmrm krr knowing sidatiom. OFFICER OR AUTHORIZED AGENT AREA NUMBER <br />CODE YEAR MO DAY <br />I..VMMGI`IIJ AIVU CAYL./YIYA IIVIV Vr AIYT v1VLAt1VtvJ (rtC/C/CgGe dll dtld(:RlRC!!(5 lft3rC~ <br />~~----- - -_..__ f•= - r'.T r ~ r , ~_ ;l.• T oCCI n ~ ~ rtf~' TF-! I `s Ott iT; f"?~,L•.. ? 1- "•~^T <br />`- ~ _ <br />r~ <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. -I'h1S i5 3 4-pmt f01-Itl. PAGE OF <br />