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PERMITTEE NAME/ADDRESS rlnrludc facilq}•.~'amdLlration if UifJrrent) <br />NAME :1„ i_ L <br />ADDRESS ,- ~ ' -' <br />cu ~z <br />FacILITY , . ; Ii. ; : l; ;_ _ - .-1 I P~i t <br />LOCATION ,- ; ~ ~ ~ ~ ~j 1 <br />. Lt~iIVL) a1AD)`. Ptifvc P"fAl~i:~61rF7 <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 />NOTE: Read Instructions before completing this form. <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 /> PERMIT ~ a . ,, - .. -;f -...:> 1.- ~ _.. ._ _ t t - _ •. -. - <br /> REQUIREMENT `~RTti ~~ t3r-<1 .~ i Fe r: <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT `s: :r ;.~?l~ ..:: a <br /> REQUIREMENT ' r+ ~ T ~ ~~ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT a3Fsl x;i-;4 a ; .: ~,t _ ._ . .. ., ~, <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 />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER 1 certifi under penalq of law that thi+document and WI uttachmenLs were ~_,- TELEPHONE DATE <br /> prepared under m\ din,.•Gun nr +uprnisiun in accordancr with a y+tem do iglud _ -----.--- - <br /> I11 a1511re that yUYllrlld peMlnael prlprrl\ gather and e\aluale tlx infornlotiun <br />` <br />--~---'-'-"' ~~~- submitted. Rasad on nrr inyuir~ of the perxal a' penom who manage the syacm. <br />~ <br />- ar thosr perwos directly respunsiMe for gathering lhr informa8un, the inlannution - _ <br />--~ ,. <br />- <br />- ~- whmittrd i+. to the hr+t Id mr Am~w I dge and Ixllef, true. accurate, and complde. <br /> <br />i <br />i <br />f <br />tl <br />SIGNATURE OF PRINCIPAL EXECUTIVE ~ ', . - ~'~ ' - ~ / <br />- - ' ~ ~' <br /> <br />TYPED OR INTED I :Im awnrr that there are+ignifrcum penalties fur aubm <br />uing ral+r <br />n <br />orma <br />lm. <br />including thr posibilit. of fine and imprisonment for knowing +hllauan+. OFFICER OR AUTHORIZED AGENT AREA <br />~ D NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />LIMIT APP <br />+_'CTIUNS - I <br />EPA Form 3320-1 (Rev. 3/991 Previous editions may be used. C7~~444 Tf11S isa 4-part fOf(Tl. <br />