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PERMITTEE NAMEIADDRESS !lecludt Facility .1'amdLocatian ijl)i,Q'annr~ NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES) <br />NAME DISCHARGE MONITORING REPORT (D R) <br />ADDRESS ~ + %', ~• <br />j_ C7x b ~ ; , PERMIT NUMBER DISCHARGE NUMBER <br />~ MONITORING PERIOD <br />FACILITY '., 1~} I itiE i. Lii-lr L.~ w Y AR MO DAY YEAR MO DAY <br />LOCATION ~_ ~.,I ;."`.7 ~ FROM TO <br />u.nFrn. f71^r'I L1F?ATTFIN MLtC,t~'. <br />riiv <br />Form Approved. <br />OMB No.2~40-0004 ~ <br />(SUI'R JG i <br />1- - FINAL <br />C!•iRUNIc~, 7!=`.iT I^OR 1GA/1? <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, <br /> <br />EX FREQUENCY <br />OF <br />S SAMPLE <br /> <br />TYPE <br /> ANALYSI <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />MEASUREMENT <br />~ <br />_~ ~ <br />~ <br />.. • ~ : ~ ,~:.- <br />.`, `.~_. <br /> <br />PERMIT <br />REQUIREMENT <br />•.i -.. ., - <br /> <br />~ •' <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <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 /> <br /> PEAMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certir. "nder penult.:~t law that min d:k~m.•m one xil "uL~i~m~nt..+.r~ <br />pn•pared under m. din ~ti~ut ur wperri+iwi in arcardu~xe with u e}sirm designeA TELEPHONE DATE <br /> w n. urr Thai yuuliricd prrwnne! prnperly Gather and eruluule the infornmtlm~ <br />\~ <br /> ."bmiucd. Bused on nn inyuin of da person or person. who mannXe the cr+irm, <br />or thnce prrwnr dirertl~ rr.+gmcihlr !nr gathrring the i"k:rmation, the in4:rr~ulion y- <br />~ <br />~ ~ ~ <br />T~ _ <br /> +uhmitted i., w the txwt of m. Mno~~l vfi;e rn+l heiief. ~nK. xrurAre, and complete SIGNATU OF PRINCIPAL EXECUTIVE /~ l~l I <br /> I "m aware that tin rr rrr .ignifirtnt penaltie. for whmitting false informathm' AREA <br />TYPED OR PRINTED including the gnsihiliy or fine a,wl imprisonmrnt for AnuwinK violutiom. OFFIC(FR OR AUTHORIZED AGENT NUMBER YEAR MQ DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />r,! t <br />~ EPA Form 3320.1 IRev 3/59) Previous editions may be used <br />As ttTO~ <br />I Nfd TESL <br />X115 I~ :i -~-~BTt'fOCfll. PAGE OF <br />