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PERMITTEE NAME/ADDRESS rlndudt Facilin.~'umdlwteaeion ifDif/'rrrntt NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS <br />PERMIT NUMBER DISCHARGE NUMBER <br />FACILITY MONITORING PERIOD <br />;;~ IyI't ;.C3iir~:._ YEAR MO DAY YEAR MO D Y <br />LOCATION _, t= N ~^ (] (j i r'; FROM TO <br />Kh1R.]~ R;=Ci..fi'i•iATI~PJ MR.°a3AGr: <br />r -- r 11VT91~ <br />DSGH~~ TC~ TR I D i <br />Form Approved. <br />OMB Nc. 2Q40-0004 <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ, FREQUENCY SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />~ <br />~ <br /> MEASUREMENT ~ " ` '~ <br /> PERMIT :, ;: . <br /> REQUIREMENT `' - <br /> SAMPLE <br />` ~ C ~- ~ - ` ~ <br />! .J 1 <br />~~~ <br />-~ <br />,~. ~~ <br /> MEASUREMENT t <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 /> 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 crrtif) under prnalh .d Lt» Ihat this dn<umrnt and ull attachmrnts wrre <br />d <br />or au <br />uccn <br />nd <br />r <br />directi <br />r <br />isi <br />n i <br />dancr with <br />str <br />dni <br />ad - j TELEPHONE DATE <br /> praparr <br />u <br />e <br />nq <br />on <br />p <br />n <br />o <br />n <br />r <br />a s~ <br />m <br />yt <br /> d. assure Ihat yunlifiad pet~nnnel pmprrlp Kather and raaluatr the information <br />1 <br /> suhminrd. tiaxd nn m~ itequin of thr pcrrnn wr prrvms »ha manage the .)~s1cm. <br />or th,rr prrvm. dirraYl~~ n p,rtsitdr for t;atheriny, thr inGmmalxm. the infortmtinn `` <br />_ <br />1 <br />~ <br /> <br />suhmiu,d i.. t.. for M•st of nn Lao»IeAgr and Ik~lirf. tam. aceurah•. and rompMtr. <br />I am a»arc th <br />are .i <br />mf <br />rnalti <br />- for wlnnuuu <br />fulx• inhn~matiun <br />d Ih <br />r <br />a <br />t <br />SIGNA RE OF PRINCIPAL EXECUTIVE <br />tl ~ <br />~ <br /> <br />TYPED OR PRINTED . <br />); <br />. <br />. <br />r <br />r <br />ic <br />n <br />p <br />R <br />maludin~ the p~nsihihty .d fiat and impriv~nmcm f••r An~"~ia~_ ,i~~lati~m.. <br />OF CER OR AUTHORIZED AGENT AREA <br />DE NUMBER <br />YEAR <br />MQ <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />!I <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be use <br />000 i' '.'Iliis.i~ a+4-part furl <br />OF <br />