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PERMITTEE NAME/ADDRESS Nndude Farilirt .\'aate//ncalinn if lh;(fntnt) <br />NAME irk; <br />ADDRESS <br />FACILITY , <br />LOCATION . • ~ :. f,1; <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES) <br />DISCHARGE MONITORING REPORT (D R) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved. <br />OMB No 2040-0004 <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ, FREQUENCY SAMPLE <br />OF <br /> _ TYPE <br />EX <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE _ <br />~ ~~~ <br />J <br />Z~ ~ I ~ ~ S t Tea <br />I N <br /> MEASUREMENT . <br /> PERMIT ,: .. is •r> ti :: <br />t ay ;_ <br /> REQUIREMENT : i•i ` - . r''' ;~i"!I-; <br /> SAMPLE <br />A <br />R <br />~ ~ <br />~, ~~ <br />~' <br />~ ~ '~C' <br />`"~•~•-A a <br /> ME <br />SU <br />EMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />< :~ <br />~ <br />`~ 1 <br />~ <br />L~ -3`~ <br />L.I^ •~ <br /> MEASUREMENT _ - <br /> PERMIT - '~~' _ . , _ <br /> REQUIREMENT - <br /> SAMPLE - <br />~~'~ -y <br />J <br />~) <br />L <br />,~-a <br /> MEASUREMENT _ - J ^.ij - <br />-- <br /> PERMIT ~ ;. t , , -r, -- <br /> REQUIREMENT ~ A~' ~ +1: , ~ ~_. "" • <br /> <br /> SAMPLE <br />R ~ •~ <br />~ '.r :• <br />`~ 7I <br />, <br />~C ~~J~r} <br /> MEASU <br />EMENT - <br />- . <br /> PERMIT •. ,~ .. ,~ <br /> REQUIREMENT ' <br /> SAMPLE <br />MEASUREMENT <br />G D~ I ~'ii <br />J• GYM <br />~ ~ <br />!~' <br />I N~T~n) <br /> <br /> PERMIT .~- ft-.•.-,_I. ~~ t: ., a_: =;1~ <br /> REQUIREMENT =;;~ • • <br /> ~ ~C~`j ~j ~ZO ~ t ~ •1n ~ ___ C? .\P <br /> MEASUREMENT <br /> PERMIT - - -,- - - _. e:. +,;" , <br /> REQUIREMENT - A`.•' : F~A:L.'r <br />NAMElTITLE PRINCIPAL EXECUTIVE OFFICER I rertih umlcr pennhy ~dlnw that Ihi. d~KUmrnt and all utluchmrnla wrre <br />i <br />i <br />i <br />ith <br />M <br />d <br />d <br />di <br />' <br />i <br />d <br />' <br />d <br />i <br />d ~ TELEPHONE DATE <br />~.` (l nn or >uprn <br />e w <br />u s <br />Qne <br />prepare <br />un <br />er m~ <br />nv <br />t <br />~ <br />on <br />n accam <br />am <br />em <br />e+ <br />to a.aurr thin yuulifird perainnrl prnprrll ~,alhcr and c. aluala• Ilx infurrnaliia+ - <br />~ <br />~,~G+ \i ~,\ ~ . '~'T ~- . ~~ ~ .uhmiuad. Ruxd nn m~ ImtUlf) nr lhr pefMM ,K prrWma wIN, nlaltaQe Iltr waem. <br />or tho.r prnon. direcNl re~p~mhiMe for KatM•rin>; Iha• information. the information '~~ <br />\~~"~ <br />~'~ ~ <br /> <br /> <br />.. <br />~ <br /> <br />whmiltad [a <br />w lhr Iwa of m. knowlyd~e and to-Ref <br />Irur <br />urcurate <br />and anmplete. <br />l <br />~.J' <br />` , <br />~ -~ (~ ~ ~ _ <br /> <br />' i ~j' ~ ~1 <br />_ `. <br />- ~ , <br />. <br />. <br />. <br />th <br />t th <br />t <br />b <br />ti <br />l <br />i <br />ti <br />I <br />v <br />ir <br />Ri <br />f <br />i <br />r <br />f SIGNATURE OF PRINCIPAL EXECUTIVE . t . <br />_ <br />- ` <br />'- <br />TYPED OR PRINTED um aware <br />rte att <br />>:n <br />penu <br />ur w <br />nK <br />a <br />-~e <br />n <br />ormn <br />a <br />ican <br />es <br />m <br />t <br />on• <br />inclndin¢Ihepn.ihilk~o(Rnrnndimpri.unmentrorl:nowin~.i,dati.m+. OFFICER OR AUTHORIZED AGENT AREA NUMBER <br />CODE YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />EPA Form 3320-1 (Rev. 3199) Previous eddions may be used <br />OF <br /> <br />