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PERMIT-TEE NAME/ADDRESS ilnrlade F'aritity A'umr/lnro(ivn if Di/ferenfl NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS <br />Bt37( ~~- - PERMIT NUMBER DISCHARGE NUMBER <br />tj ' <br />FACILrrY :~ ~ ~,., :, ;.; ; ;;: MONITORING PERIOD <br />LOCATION YEAR MO DAY YEAR MO. DAY <br />' - -- - FROM TO <br />_-~,N-. r #~AT3E. i`i I ~I= MAI~EraGr •. <br />Form Approved. <br />OMB No. 2040-0004 <br />~~U!~k ; I <br />- F i t~.~L I`ihl <br />HR~~TU7e', iricT TE~'JTIR~ra POFt' GCi9:k <br />/'~~:. _ <br />NOTE: Read Instructions t~efore completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE ' <br /> MEASUREMENT <br /> PERMIT .. o-'; .. ~, i ,. - ., - .• ~- .-. I ' <br /> REQUIREMENT N1W VAL-ti=' ~ ~ <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 />NAMElPITLE PRINCIPAL EXECUTIVE OFFICER I certif. under prndq of law that this ducumem and nll attnchmenb were <br />prcpnnd under m~ dirntlwn or wpenision In oecordartcr with u s):Hem designed <br />-- TELEPHONE DATE <br />_ <br />- to assure Thal qualified pers,rond proprrl~ gather and r. nluatr lhr information '~ - -~'- - <br />_ <br />1 whmftled. Raid on me inyuin of the person nr penons who mannge the sptrm, I <br /> or thus pcnuns dinxtly rnq,miMr for gatherirq, the intornwtion, the Information ~ ~ ~ - ' <br />~ <br />I G-' `.+_ ~'~ ' " <br />` ~ suhmittrd is. m the hest nt m. knowledge aml hdlrt, true, accurate, and complete. i ~ <br />~ I ~ --- <br />~ <br />~ 1 am awan• that there arc si <br />nificnm <br />rnnltirs fur suhmittir <br />adon <br />lake infur SIGNATURE OF PRINCIPAL EXECUTIVE ~ <br />TYPED OR P NTED p <br />yt <br />m <br />. <br />g <br />including the pxsihiliry of fine and imprisonmrm for knowing ~i,dnUons OFFICER OR AUTHORIZED AGENT AREA NUMBER <br />CODE YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all atlachments here) <br />,1: <br />.i <br />EPA Form 3320-t (Rev. 3199) Pre~nous editrons may be used. TtTtS 1S 3 ~-p:ItC tOTril. PAGE OF <br />