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PERMITTEE NAME/ADDRESS !lncludr facUlr) A'amt/LotaNan iJDiJfornd <br />NAME <br />ADDRESS - -' ; ' <br />pax ,:. ~ ~a <br />,_;E;V ;' 3 t~ 1.534 <br />FACILITY '_:i..A p)jiv~, ~~~`F~~F'yl <br />LOCATION _;~~ ,- _~ ~ 1 hey <br />r' YtARi7: R~OL~1`ir-1TIpN I-iANAGER <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 DAY <br />FROM TO <br />Form Approved. <br />OMB No. 2 X40-0004 ~ <br />r - i- 1 <br />NOTE: Read Instructions before completing this torm. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY <br />OF SAMPLE <br /> EX LYSIS TYPE <br /> ANA <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE } <br />' <br />\ " y (i `,~~ <br /> MEASUREMENT / <br />v <br />~ <br /> PERMIT ' <br /> REQUIREMENT <br /> SAMPLE ~ <br /> MEASUREMENT -~ • <br /> PERMIT • <br /> REQUIREMENT <br /> SAMPLE <br />1 <br />` <br /> MEASUREMENT 1 <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />MEASUREMENT <br />~ ~ <br />= ~ ~~'J J <br /> PERMIT P <br /> REQUIREMENT <br /> SAMPLE <br />MEASUREMENT f <br />~ ~ ~' --~ ~ ~ <br />' ~~ ~ ~/ <br />~ ' ~~- <br />` ~ ~ J <br /> PERMIT - .1: ...; <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT `-~ ~ `~ I ~ <br /> PERMIT ~ • `' i . _ <br /> REQUIREMENT - ~ ~' <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />TELEPHONE <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I cYnih under penalty of low tbut this diKUmrnt and ull attachment. wen DATE ~ <br />^ <br />pnparrd under ms direction or supra isinn in xcordanrr with a system drsigaed <br />W wtisure that yualificd prrwnnel pnyurly ¢ather and rsaluatr the inlurmatMn <br />1 <br />ntbmiurd. Rusrd nn m) inyuin of the prnnn or perwm. who manage the system. <br />~ <br />ur tho.e pcrwns dimtl~ resfwmsihle for gathering thr information, ihr information <br />, <br />lete <br />taws of <br />ow{rd <br />and t,elief <br />true <br />x,vratr <br />and com <br />itnd i <br />w th <br />A <br />b <br />, <br />, <br />p <br />. <br />m <br />s, <br />m~ <br />n <br />Re <br />. <br />su <br />e <br />SIGN TORE OF PRINCIPAL EXECUTIVE i <br /> I am aware that there are significam ltrnaltit+ for submiuing false Inlormatirm, <br />m f <br />wi <br />vi <br />ti <br />f <br />d i <br />i <br />k <br />d O ICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MQ <br />DAY <br />TYPED OR PRINTED sonmr <br />no <br />ng <br />a <br />uns, <br />including the p,nsibiliiy of <br />loc an <br />mpr <br />or <br />~ ; DE <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />EPA Form 3320-i ;Fev 3+vj~ P~C:iOCS .,,,-~~., r-=: ~r~ ~.;~.~; This I~ Q -~ I)171-i ii~Illl. PAGE OF <br />