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PERMIrT!!E NAME/ADDRESS tlnrlude• F'arility .~'amr/IiKOtinn iJlh;/fnrntl NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />N~ME DISCHARGE MONITORING REPORT (DMR) <br />ADD~tESS <br />I C•C?UtV ; 'Y PERMIT NUMBER DISCHARGE NUMBER <br />=~~us ~ -' <br />FACILITY , C Or}IL 1-Z I P~'t MONITORING PERIOD <br />LOCATION -ERU`; r'; YEAR MO DAY YEAR MO DAY <br />FROM TO <br />MIN <br />(SL1 <br />F - <br />nlo~ <br />Form Approyy~~d. <br />OMB No. 20II0-000A <br />~Y <br />NOTE: Read Instructions before completing this Corm. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ, <br /> <br />EX FREQUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE - <br /> MEASUREMENT <br />. <br />_ ... <br /> PERMIT ~ .. .. -. ,. ,_ ~ <br /> REQUIREMENT '•"`; `. ~I~1~''~1 <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT Y.^ ~ >-. <br /> REQUIREMENT ' <br /> SAMPLE ~ i <br /> MEASUREMENT _ <br />~ <br />.~ <br /> - <br /> PERMIT t.., . - .. ~ ( <br />r . _ , <br />` <br /> REQUIREMENT l ~ >~i '' ~ { <br /> SAMPLE ~ <br />~` 1 <br /> MEASUREMENT ~ j <br />' ~ <br />~ <br />~ <br />: <br /> PERMIT ~ .. .r • - .._ , . <br />, <br />. <br /> REQUIREMENT :~'''•I ~ I.; <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT .. -~ _ _ _ . ~; . <br /> REQUIREMENT - ` <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - . -~ .. _. •., _ -- <br /> REQUIREMENT _, '• ice; i <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT _ ~- ~ .. , - ~ • - <br /> REQUIREMENT = ~-'r~ a ' " ~-' <br />NAMElfITLE PRINCIPAL EXECUTIVE OFFICER 1 certify unda•r prnxlh of low thxl Ihi+documcnl and all atWAlmenh were <br />• <br />i <br />d <br />d <br />di <br />ti <br />i <br />i <br />d <br />ith <br />d <br />i <br />d TELEPHONE DATE <br /> <br />' - r - ~ i•' e /l/ U, / ' , on or wpa <br />n accor <br />ance w <br />prrpure <br />un <br />er m) <br />rrr <br />n <br />+ <br />on <br />a +yaem <br />r <br />>;ne <br />In a++ure thul qualified prr+annd prnperl~ Calhrr and e~alualc the Infnrmalion ~. <br />' <br /> wbmittrd. Rxvd nn m~ ingmn of tht• prnon or prrwn. who mxtwKr the +jstrm. ~- <br /> ur Ihnv Ixrvnn+direcd~ nvlxmsiblr !ur KnthrrinK the infurmalK,n. Ihr information <br />~ <br /> to the Iwsl of ml km~wladke and lxlicf <br />whmiltrd i+ <br />Ina <br />u.runle <br />xnd a'nmpkte r ~ <br />~ ~ ~ • ~ <br /> , <br />. <br />, <br />, <br />1 <br />i <br />ilti <br />f <br />ti <br />th <br />M• <br />if <br />l <br />l6 <br />f <br />b <br />f <br />l <br />i SIGNATURE OF PRINCIPAL EXECUTIVE ~ Ci 1 ~ S <br /> <br />TYPED OR PRINTED Qn <br />pena <br />or w <br />on. <br />am aware <br />xl I <br />re are + <br />ican <br />e+ <br />m <br />lyt <br />a <br />+e <br />n <br />orma <br />uuiudint; the px+ihilih of fmr xnd impri+nnnxnl for knowin>; ciululinn~. <br />OFFICER OR AUTHORIZED AGENT <br />AREA NUMBER YEAR MQ DAY <br />CODE <br />CVMMENTS AND EXPLANATION OF ANY VIOLAIIVNS (Hererence an aaacnments Here) <br />24-~-If? WRFC I <br />EPA Form~320-1 (Rev. 3'99) Prevrous editions may be usetl. G~p~~ ~I~lis t9 a ~3-p~tf FOiltl. PAGE OF <br />