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PERMITTEE NAME/ADDRESS 1Include fariGq .\'mm~iLn~ or:.oi .! Di_!!, r.nr• NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDE$) <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS _ , <br />+'}X r- PERMIT NUMBER DISCNARGENUMBER <br />FACILITY MONITORING PERIOD <br />L YEAR MO DAY YEAR MO D Y <br />LOCATION ~- FROM TO <br />Form Approved. <br />OMB No. 2040.0004 <br />rail, <br />c ~' <br />• "Kjl;_ , <br />UfSC~t~RG>=' TC1 °A•"';E CI?~EI~ <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 ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />ME --. <br /> ASUREMENT .. ~ - <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE ' <br /> <br /> MEASUREMENT ~ ~„ <br /> PERMIT ~ - <br /> REQUIREMENT <br /> SAMPLE <br />~ _ <br /> MEASUREMENT , I ~- <br /> PERMIT -- <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT ~ <br />v <br /> PERMIT .. _ k <br /> REQUIREMENT - - <br /> SAMPLE -, <br />~ <br />~ <br /> MEASUREMENT _: ~ (, i _ - ,,_~ <br /> PERMIT ,: f r ; r: • , r <br /> REQUIREMENT - r•ii)i S : ; <br /> SAMPLE - <br />~ • ~ <br />~ ~ <br />r <br />» - ~L.; ~, :~ i .,~., MEASUREMENT ` . t ~ ~ <br />' PERMIT .. ,<_.r't_I . <br /> REQUIREMENT ,= : L ;' • <br /> SAMPLE <br /> MEASUREMENT t ( t~ i_- - <br /> PERMIT ~ .. • <br /> REQUIREMENT ' <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I rcrtil~ under prnalla of Wx fT,ut Ihi. A.MUmem and :dl utWChmrnts xere <br />a nYf und <br />. Ai <br />li <br />i <br />i <br />i <br />d <br />i <br />h <br />- <br />A <br />~ TELEPHONE DATE <br /> pap <br />er m <br />rs. <br />on ur wprrv <br />ance x <br />s <br />on <br />n accor <br />l <br />u .~ <br />ctrm <br />ignrd <br />a. - <br /> to acarrc that yualifiad prnonurl prnyerl~ Kuther and ra oduatr the infonnatlon _ <br /> auhmiurA. 1{asrd nn m. inquiry o(thr IK n„n ..r pcnonh x~ho manaKe tha• s~atrm. ~ <br />~ <br /> or th,ne I,enun. din~a~lly nwpm•iMe for galhrrinx Ihr information, the informaliam _ _. <br /> <br />.uhmittad i.. In the 1>twt of my Arn.xlrAl;e and Ixlirf. tn~r. aarurote, and compkln I <br /> <br />1 and ilwarC IhYI Ihrrr arC ai};nirleanl pCnalllrc (,m ~ahnlltling (11fKr Inhlrrilal11n1 SIGN LURE OF PRINCIPAL EXECUTIVE t <br />- 1 <br />TYPED OR PRINTED . <br />mrtudinK the {rncihilih of fine and imprirnnmrnt for knnxin, aiolatl,m., OF CER OR AUTHORIZED AGENT AREA NUMBER <br />CODE YEAR MO DAY <br />vv.......... ... '..... ~... ............, . ... ...... .... "-....... la.crcr cr.a.c are naaoa.nnrasana ncr c~ <br />T <br />s <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. <br />ia4~:' Thl <br />OF <br />