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PERMITTEE NAME/ADDRESS !include Facilifr ,\'amdliuatian ijUifjrrenrr <br />NAME <br />ADDRESS <br />FACILITY h r ; . i •i,= :. •~1":' _.. ~ t <br />LOCATION i , EN ~ Q ~ 1 b 39 <br />ri w rn .-s oCrt nMn Y T r'111t FYAIlIG(`_FG <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO D Y <br />FROM TO <br />Form Approved. <br />OMB No 2840.0004 <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION ND, <br /> <br />EX FREQUENCY <br />OF <br />ANALYSIS SAMPLE <br /> <br />TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />MEASUREMENT <br />~ r . ,-.r <br />t ' '•, t ~ y4 <br />~ , ` <br />~ ~- <br />i ~. <br />/ u F: - <br />t _ _ _ __ <br />- <br /> <br /> PERMIT <br />REQUIREMENT ~ <br /> SAMPLE <br />MEASUREMENT <br /> <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br />MEASUREMENT <br /> <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br />MEASUREMENT <br /> <br /> PERMIT <br />REQUIREMENT <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 />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certif. under penuln of law thm this document and :di attachment were <br />prepared under m} directirm or supervision in wcurdance with a ssslrm designed TELEPHONE DATE <br /> to rsure Ihut yurlinrd prrconnel prnpcrl~ gather and e~aluatc the informatlnn <br />submitted. Rased nn m~ inyuin of ihr prnun or prrsom whu man¢gr the s~strm. <br />msible fur g¢Ihering the information, lhr information <br />s directl <br />n <br />Ihosr <br />a <br />/ ~ ~ <br /> <br />~ <br />1 <br /> <br />1 <br />i <br /> i <br />p <br />nr <br />prn <br />n <br />submitted h, to the hest of ms knowirdge and belief, true, ¢ccurota and complete, SIGNA RE OF PRINCIPAL EXECUTIVE ~ <br /> I ¢m aware that there are signifnynt penalties for submitting false informadon. F CER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br />TYPED OR PRINTED including the possibiliq of fine and imprisonment for knnwinp sidatiom. O <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attacnmenrs nere~ ~ / ~ ~rTpX IC ITY" . RPT LQWEST' <br />-'t~3rHt ?, RFPRQC~ FT1=F I~.AT1~1\!S A~ <br />• -~.Ir- <br />T711S l~'c1 ~-~iift fOritl. PAGE OF <br />EP:. Form 3320-I (Rev. 3/99) Previous editions may be used <br />