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PERMITTEE NAMElADDRESS rlncludr Farilue YamdLutatian i/bif/rrrnr~ NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDESJ <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS <br />FAX PERMIT NUMBER DISCHARGE NUMBER <br />~~ MONITORING PERIOD <br />FACILITY •~ ~, hl ~ ; `i,E L ~I'~Y `. r; <br />LOCATION r,• ~ ~ YEAR MO DAY YEAR MO DAY <br />.F_IV ..O S ~ ~ FROM TO <br />•~ Lf nF%!l ~7 Ff~! IIML~T 7 rltV MAMA.^.F ' <br />Form Approved. <br />OMB No. 2~0-0004 ~ <br />I~f I f•~ <br />(SI: ; <br />DSGI-tG T© 7RIDi ~7QH GREFM~ <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION <br />NO. FREQUENCY <br /> <br />OF <br />SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE ~ i <br />' r-- <br /> MEASUREMENT " r. <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 /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAMElfITLE PRINCIPAL EXECUTIVE OFFICER I rrrtir> unda•r lu•nalt~ urlaw Ihel Ihi. dtwvment and all alt:n•hmrnr. wrra• - I •' TELEPHONE DATE <br /> prrparad under nn dimtion or wprni.ian in arcordaorr xith a rydrm drtii~ned <br /> la u~~urr that yunlificd prrWmnel prnprrl) t+alha•r ettd rvehwle Ihr infurmalion <br /> .uhmittcd. Bard on m~ inquin or Ihr prrrnn or prrwnt. who mmuy,r Iha• yatrm. <br />ur Ihr..r prn~m. direa~tla rap+m.ihla• r..r KathrrinQ Iha• informetirnt. Ihr inlnrmulion ) ,~, -'7 i <br />/ ~ <br /> .ubmittrd i., to the Ix"at ur m} knowlydKr and M•lirf. Irua•, aarurale, and complete. <br />SIGNATUR OF PRINCIPAL EXECUTIVE ~ . _ <br />I <br />TYPED OR PRINTED I am aware Ihat there arr.ipnifiaem IK+nuhia fur.ubmiUinR rely Intnrtnetion. <br />imludinK the p,..ihilin of fine and imprwortmrm for AnowinA.4dation>. OFFIC OR AUTHORIZED AGENT AREDA NUMBER YEAR MO DAY ~ <br />GUMMENTS ANU tAYLANAIIUN Vt ANi VIVLAIIVIVD tnererence an alracnmem~ nere~ <br />>E <br />~. i <br />EPA Form 3320-1 (Rev. 399) Previous editions may be used. il~~ , T1ti~ <br />