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PERMITTEE NAME/ADDRESS rrncludr Facilu}• A'amdlocation iJDi/jenml <br />NAME <br />ADDRESS <br />FACILITY ~._; r, , : i •:t ...~, ir' ~ ~~ . <br />LOCATION ~~ ~I'J C CJ ~) 1 b3~ <br />.. r~r. ever. r. t.~n l"Yt'IAI MAnfAr~l=p <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. 2040-0004 <br />•• ~ a <br />~ SL <br />1` - <br />CNF <br />NOTE: Read Instructions before completing this form. <br /> <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREGUENCY <br />OF SAMPLE <br /> EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT ~~~ -~- ' <br /> . <br /> PERMIT <br /> IREMENT <br /> REQU <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 I•' ~ <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 />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I .rrt.r. under prnalry td law thin thiv d~MlLtllenl and au atwrhmenty were <br />pra•pnrrd wafer m. direction or wpenis{on in accordance with a ryvtrm do Igned TELEPHONE DATE <br /> ~~~ u..urr that yualifkd prraonnd pmpcrty gather and evaluate the infnrmati~m <br /> wbmitted. Hand on my Imluin of the prrvrm or perWata who manage the yvirm. <br />mvihlr roe Ipthering the in(ortnntiwn, the information <br />res <br />di <br />U <br />h ; <br />~ <br />~ <br /> p <br />or t <br />ou prn.mv <br />rec <br />~ <br />vubmiurd ic, to the bra td m. knowkdgr and hrlieL true. acruratr. and rnmplete. SIGNATURE OF PRINCIPAL EXECUTIVE ~ <br /> 1 um aware that there are vignifa~am {x•nalties for whmitting falvc• information, eR OR AUTHORIZED AGENT <br />OFFIC AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br />TYPED OR PRINTED including the prcsihilih or Iinr aml impri.onmrnt for Mm.wing vl~dationv. / D <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Hererence an arracnmenrs nere~ <br />;Nr.tT~ ~. RE'F'ROi' r~ERIVATICI-+!S A5 "TOXICITY". RPT LOWEST <br />,. r <br />T'ttis IS a ~-~Att (Ornl. PAGE OF <br />EPA Form 3320-i (Rev. 3/99) Previous editions may be used <br />