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PERMITTEE NAME/ADORESS ilncludr Foritin•.\'amr/LouTlion ifDiffrrrnt) NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS - .- <br />HC}i; ,_ PERMIT NUMBER DISCHARGE NUMBER <br />1~N <br />FACILITY `:4•A "P`lINL ~: vi•f%' ~..-: MONITORING PERIOD <br />LOCATION ~F.N e, Q 9 Z t FROM YEAR O DAY TO YEAR MO DAY <br />1' KAh'Q, REt;I.AI`iAT I f;N t"Ir~,NAGt- <br />Form Approved <br />OMB No- 21~p-0004 a <br />PI1f.i i:; <br />{ St~L~: ' ' "~ <br />E' ? 4Ct-^::s~jr r. 7t': -rR ? $ ; r r cly CREEf~ <br />NOTE: Read Instructions before completlnq this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION N0, FREQUENCY SAMPLE <br /> OF <br />TYPE <br /> EX ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE ~ ~ <br />~ <br />/ <br />~ I i <br />~ <br />~ ` <br /> MEASUREMENT - <br />~ _ <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE ) I , <br />~ <br />' <br /> MEASUREMENT ~tii o + - - „ <br /> PERMIT r -- - <br /> REQUIREMENT <br /> SAMPLE ~ <br />~ //, `~ , <br /> MEASUREMENT ~ ( -- ~ <br />~_/ C. ~ ' ~ rJ <br /> PERMIT _ <br /> REQUIREMENT •~ - <br /> SAMPLE j <br />` <br /> <br />MEASUREMENT <br />I <br />t __ <br /> PERMIT ~ - - -r •: ~ ~ --~~ <br /> REQUIREMENT •-~ .~ <br /> SAMPLE _ <br />~ ~ , i ~" I <br />V <br />!~ <br />~'~ <br />", • <br />- MEASUREMENT 1 <br />~ ~ l~ . <br />- <br />'•' PERMIT _ , ... . ~ , <br /> .REQUIREMENT .-.. ~ (... iy ~.. ~. 7 t ~ ~ ~ L' <br /> SAMPLE / - ~ ~_ ~--- r i <br /> MEASUREMENT -~ r.~ `~ <br /> PERMIT 14 _: t _. <br /> REQUIREMENT <br /> SAMPLE <br />r <br />I <br /> MEASUREMENT ~ <br />-' 1 ) ~ <br />, ~ <br /> PERMIT :.~ .. ~ .. ._ ,,-, <br /> REQUIREMENT r ' '~ ~~~ ~ i'~ ` - <br />NAME/T1TLE PRINCIPAL EXECUTIVE OFFICER I rrrtiry under penalq wf law that Ihia document and all attnchmrn~a were <br />d <br />ti <br />d <br />di <br />~i <br />i <br />i <br />• <br />d <br />h TELEPHONE DATE <br /> prrparc <br />un <br />er m7 <br />on or wpen <br />rn <br />+ <br />on <br />n ara <br />nt <br />arne wit <br />a ss+tem drsiglred <br /> to aawrc Thal yunlifird penomlrl grape rl~ gather and rvalunlr Ihr infnnnallnn <br /> <br />wbmitled. tTnxd an m f inyuin of the perv,n or prraons who manage lhr y stem, t <br />i <br /> or Ihmr persons dirrctly rrsponaihle for gatherirgt thr information. the information ~ <br /> <br />suhmitted k, tw the he+t of m. Anowl vigr and Iwlu•L true, nccuralr, and rompkta <br />1 am awnrc that thrrc are si):ndcant prnaltfr+ G.r +uhmilting fnlx information <br />SIGNI~TURE OF PRINCIPAL EXECUTIVE I <br /> <br />TYPED OR PRINTED , <br />including for prKaibflits of floe :md impriaonmrm k~r Lnowing vhdutinn+. <br />OF ICER OR AUTHORIZED AGENT <br />AREA NUMBER <br />CODE <br />YEAR <br />MO <br />DAY <br />V V1Y1m G1~ 1 J Ml~v Gnr LMI~M 1IVI\ Vr MI`1 T YIVLM I IVIVJ (I•l Cl CICn(:C all altdl:nmenf~ nerel <br />'E <br />VRDEN t7F PROt <br />EPA Form 3320.1 (Rev. 3199) Previous editions may be used. Tf11~ i~ a ~-~8i'f'1Ot711. PAGE <br />