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PERMITTEE NAME/ADDRESSllxelud~ FxiGry ~1'antdleKatian if !A,/j'irenrl ~ RATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDESJ <br />NAME r.. r DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS <br />i j . . PERMIT NUMBER DISCHARGE NUMBER <br />_IvWG MONITORING PERIOD <br />FACILITY , _ ly ~ <br />YEAR MO OAY Y AR MO DAY <br />LOCATION r R ~ ~ FROM TO <br />P?INOR <br />F •- FIfvALi' <br />5UR f- <t'_ i ~ V N <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• <br /> <br />EX fREOUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE L ~ <br />~ ~- Icy" ~ ; ~ I~-ISt~ <br /> MEASUREMENT . <br /> PERMIT ;; ;f t ~_. ~ 7 •a , -::v ,.:_ ~ ~ , <br /> REQUIREMENT ~'~ I f •< ] ''!t-%"'~ "'I~ '+~{ `~H <br /> SAMPLE s , -~ ~ <br />; ~~ ~' f - r" . '~-t2A~ <br /> MEASUREMENT ~. - - <br /> <br /> REQUIREMENT ~ ~'~`r'% ' (} <br /> SAMPLE <br />~ ~~ ~ <br />! C~• ~ ~t <br />fl <br />_~ ~,.J <br />~ ` ~?•1L <br /> MEASUREMENT <br /> PERMIT s -.. •~•~- : ; :. , • r. .. ~• ~~ <br /> REQUIREMENT '~QC'<', F!`;':, ilr;; i r t';":' .-r <br /> I ~~ ~ ~`~ ~ <br />~' ' I ~ ~ ~A ~ <br /> MEASUREMENT ' <br /> PERMIT ~: a y:.: - .. ~ < ~~ .. .. .. ~ ~, ~., <br /> REQUIREMENT ": L ' 11- 'Y i°I X. <br /> SAMPLE , , `~ ~~' ~ ~ <br />~ ~"'' 'fig <br /> MEASUREMENT --~-- <br /> PERMIT , c . ~~ ~, t .. :. r .., -, <br />~ REQUIREMENT '~I! •lTi; <br /> ~l ~~ ~~~ ~ ~ 1 A <br /> MEASUREMENT <br /> PERMIT #;t -? .~ :,..;~ -S - ., .. <br /> REQUIREMENT `~`-; ~ `'~"t~- <br /> Q <br />(~t <br />c ~ Llb ~ I ~-~- Ir~ST~I <br /> MEASUREMENT • <br />, <br />. <br /> PERMIT •- ~ - `< ~ - - - - .. .... - ~ _ , , <br /> REOUIREMENT ~'~' - - - <br />NAMElfITLE PRINCIPAL EXECUTIVE OFFICER I crrtiH under pcnalh of lax thin this d~runmm and all nuachnu•n~ »erc <br />d ~ ~_ : ~ <br />-- ' TELEPHONE DATE <br />- <br />~ <br />, <br />-> prrpsn•d under m} dircctiua or wprntcwn m acronlunce with :~ ry.rtm <br />esig~nvl <br />u <br />to <br />that <br />uli6 <br />d <br />~ <br />r <br />~l <br />e <br />l <br />athe <br />a <br />d r~ <br />h <br />t <br />d <br />i <br />fo <br />6o / <br />~~ <br />\ <br />V ~ <br />t S- , ~ <br />- ~ J ~ ~ u.ave <br />yu <br />e <br />IK <br />n <br />n <br />n <br />pmp <br />r <br />~ g <br />r <br />n <br />a <br />m <br />e <br />te <br />n <br />rma <br />a <br />6mined <br />uire of the <br />nr <br />rwne Mbu muna <br />r the ~ <br />strm <br />N <br />d nn <br />. in <br />~u~ ~ <br /> <br />1 -- ) <br />. <br />at <br />. <br />or <br />m <br />q <br />pe <br />n <br />pe <br />g <br />ur Ih~.x perWm. direclh ra+twm~iMc Gar Calberinc Ihr infornwlion. the infnrmnliun <br />~ • -, j ~ - <br />~ <br />' <br />~`- ~ - ~ - _ .- ~ubmitt~d i.. to the IKa ~~r m. Atwrlavl~t and brlief. Irua•.ucrurate, and cumpkte. <br />h <br />~ <br />i <br />if <br />f <br />b <br />( SIGNATURE OF PRINCIPAL EXECUTIVE t' ~ t-,'t'' y `~' ^S ~~ 4~ ice! r '1 <br />'~ <br /> <br />TYPED OR PRINTED 1 um aNUrr thin t <br />en an <br />. <br />gn <br />u~nt prnallie~ <br />ur .u <br />mitlin><fula• in <br />ormaUoo• <br />including th. P'^`it'ilit. ^f Rnc anA impci.onment 6.r AnoHing,i~~Iutlom. OFFICER OR AUTHORIZED AGENT AREA <br />ODE NUMBER <br />YEAR <br />MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />EPA Form 3320.1 (Rev. 3/99) Previous editions may be <br />