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PERMITTEE NAME/ADDRESS rlnclude FaeiWy :\'amelLorarinn iJIhJJerrnO <br />NAME i•i T't\}]r!'4 <br />ADDRESS <br /> <br /> <br />FACILITY ~.~ I ~~ ' <br />LOCATION 1-~R~~K _: L7 $U~: <br /> <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 />M I fV CIR <br />{ ~V>3ri ..1G i <br />F - ~ I ivr;L. <br />~~~~ i,cF ~I_~IVaFr -ra THI <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, <br /> <br />EX FREQUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> <br /> SAMPLE <br />~ <br />~ <br />~ I <br />j <br />~1 <br /> '~ G' ~ G' ~~ L' <br /> MEASUREMENT t <br /> PERMIT .: it ; i, Rat.- r3 T I:, t > ~ ~.: ._ t'. - <br /> REQUIREMENT ~;C`G~ ~4tiJ'~- ~ : l 'r r ~•vi`1~~~ 1 <br /> SAMPLE <br />- <br />~ I ~ <br />< I O <br />~ <br />/ <br />~ <br />/ ~~ <br /> MEASUREMENT ' ' <br />`- <br />- <br /> PERMIT A..*~ ~ . )f~; I - Gr. <br /> REQUIREMENT , .. ` i_'>r rl <br /> ~ '~ ~' ~ ` ~`~ ~~1 <br /> MEASUREMENT ~ <br />-' <br /> PERMIT ~._,~.,, ?. . , , r•~ <br /> REQUIREMENT A'.'•:: i?:'`. I L Y !°! ' „.;f•;i ' <br /> SAMPLE <br />~ <br />~ <br />I ~ <br />'-' <br /> MEASUREMENT <br /> PERMIT ~ 4:. ~ - ; •' ~ _ • I r r , . ~. - .~ <br /> REQUIREMENT .,, :`• ,•.^; r~+~_; ~~ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT . <br /> ,~ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT , <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I rcrtiry under penaNe ofl:n. that this deaumenl and all atluchmrnte ware ~ -='r' I <br />prrpartd u,aler nn dirr. tam ar wperricion In ucrordntwe with a srNem Atwittnrd <br />~=_ <br />1r TELEPHONE DATE <br />f <br />' ~ _ <br />~ <br />ti <br />--- ~-- <br />1 <br />i <br />r <br /> <br />\ ` <br />`,~'G~`. - ~ ~-1~~ • <br />~~~ ~ ~r` _ ...rte <br />unue <br />un <br />u~ s~ wee that qualilittl Ih~n~mm• <br />proprrlr gather and evulualr tha• <br />n <br />wbmiaed. ftaed un m, ~nyuin cif the per..m ur prnun. whu muneae the .y~tem. 1C = -;_ <br />~V <br /> <br />~ ~ - or Ihox• pvr.am dlreetl. „~.Iwrn.ible G,r tez,therinR the ink,rmaliun. Iha• Information <br />o <br />t <br />th <br />A <br />wlyd <br />d I <br />•Ikr <br />t <br />• <br />a <br />d <br />let <br />h <br />i <br />d i <br />b <br />~ ~ - ~- <br />, , r. ~I-:~,- - •-~ ~ ! 1 _ <br />~' f <br />x <br />~ sm <br />tw <br />ly an <br />x <br />, true. ua rurn <br />a <br />, <br />n <br />c <br />mp <br />e. <br />w <br />m <br />[ <br />a <br />., b. <br />e <br />rs ~~ <br />I am aware thst thenCas• ~~¢nificant penalties for ~uhmiltin~ rake inG,rmation. SIGNATURE OF PRINCIPAL EXECUTIVE ~ ~ <br /> <br />TYPED OR PRINTED indudin ~ the shNlt, nl fnx• and im risonntem for Anowin inlmions. OFFICER OR AUTHORIZED AGENT AREA NUMBER YEAR MO DAY <br />~ l'.'.`. p t: ` CODE <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference air anacnments here) <br />EPA Form 3320.1 (Rev. 3199) Previous ed <br />This i. a ~-part form. PAGE of <br />