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PERMITTEE NAME/ADDRESS t(nr(ude FariGtr .fume/(.ueafinn iflbffenml <br />NAME <br />ADDRESS _ ' i t_ '~: ill''." ~_ F'. ' <br />7« <br />1..' L rJ~ f? J t <br />FACILITY I+I i C1 ~ C CJ!'l l° L E 7S , • <br />LOCATION I GO ~ ~ ~~. 3` <br />•: 1p P1. G+1~f 1 .]F1dT ~f'1Nf M~1Vs1?'==A <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />DISCHARGE MONITORING REPORT (DMR) ,~,I • <br />;< <br />PERMIT NUMBER DISCHARGE NUMBER f" <br />ry <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />O!AE P. ,.2t~4u-0004 a <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREGUENCY SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANAI_rsls <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE r <br />• MEASUREMENT l r_~ ~"' <br /> PERMIT ''r~ <br /> REQUIREMENT - . ~ . <br /> SAMPLE - j ! ~ <br />` <br /> MEASUREMENT ~~ ~ J <br /> PERMIT - <br /> REQUIREMENT ' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I r~*ur~ andrr I:rnatn una» that thi. d:a ument and uu attarhmrm+ »rre <br />r <br />red wtdrr <br />. dirr <br />ur <br />rr »itlt a +t+t <br />•tiu <br />r+icio <br />i <br />rd <br />drsi <br />n <br />l TELEPHONE DATE <br /> p <br />epa <br />m <br />a <br />n <br />wlx <br />n <br />n nro <br />an <br />rm <br />g <br />ev <br /> to a+wre that qualiRrd pervmnel proprrir gat M•r and eraluatr the infurmati:m <br /> wbmiucd. Itr+td nn m. inyuin of the q•r~m or Ixrwm »ho manaya• Ihr +y+lem. <br />ur IMae petv,m direrU~ re+pta+ih4r fur gat hrring the indirmutinn, the m(ormation `~ _,~ <br />t <br />+ _ <br /> <br />+uMnitted l+. t.. Ihr he+t of m. Anu»hvlge• and IKlirf, true, accurate. and complete. <br />I <br />» <br />th <br />t th <br />i <br />f <br />itti <br />i <br />f <br />ti <br />i <br />if <br />l <br />l <br />b <br />f <br />l <br />SIGNATURE OF PRINCIPAL EXECUTIVE ( I I <br /> um a <br />ure <br />ere ore s <br />or su <br />m <br />+e <br />orma <br />a <br />gn <br />icnn <br />pena <br />[ <br />t:. <br />ng <br />n <br />n <br />on. <br />OFFI <br />ER OR AUTHORIZED AGENT <br />ARF A <br />TYPED OR PRINTED including the q:++ibiliry of fine and imprisontttrm Hu kno»ing+iedatinne. ¢ <br />L --- .._ NUMBER <br />COUF, YEAR MO DAY <br />COMMENTS ANO EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) / <br />%IRF.A TD REQUEST A FLEA; <br />EpA Form 3320-1 (Rev. 3199) Provious editions may be used. "-' 1 .j~ T'fti~`-iti a 4-{curt form. <br />