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PERMITTEE NAME/ADDRESS /Include Ftuiliry :1'amdLxotiou ijUijjenwl NATIONAL POLWTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />NAME -;., DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS <br />PERMIT NUMBER DISCHARGE NUMBER <br />• ~ ~ MONITORING PERIOD <br />FACILITY ~ r -;; ~ ~'I I NE YEAR MO DAY YEAR MO DAY <br />LOCATION - C O ~ FROM TO <br />'_.; <br />14A1f"~ LtGT1F. l+ITtJF MAPJ.4C: <br />MI <br />~c <br />F <br />Form Approved. <br />OMB No. 2040-0004 <br />3R&.F1Ii~tE TRivG TR IB TO ~ t~~-c D <br />•~ <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY <br />OF SAMPLE <br /> EX S TYPE <br /> ANALYSI <br /> AVERAGE ~ MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE j <br />" MEASUREMENT] <br /> PERMIT ff - ._. F. -.~. ~:>-( ;-:;~,~~_:,~ ;- ,:_., ;.. ,, .. <br /> REQUIREMENT I ';V6 l:+n: (_ -' `. ~ `"I„ ' T' <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT ',t• ~- ~ a•'rr>` : i::l't.:.* ; r, rr _t . <br />REQUIREMENT : ~ r~ =, _ IJK i. i. <br />SAMPLE <br />MEASUREMENT <br /> PERMIT r.:,- •' i` `.. ~ < - t' <br /> REQUIREMENT ~ - L>,~; i L'; f-i k - <br /> SAMPLE <br />J iL MEASUREMENT <br />,, PERMIT ~ ..~ ... <br />r_ <br />• <br /> REQUIREMENT ~ `• Vv ~ ~`! x. i•= <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~~. ;. ., -~~tE••~~'~• r. tr: ~ 3.:~ r~.. ~ i-. . <br /> REQUIREMENT r ~='~ - -~-~ AVC gAIL.Y FIX <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ^... ,, .,.... _ <br />'G' <br />~7~''r• <br />' <br />;` _ r <br />Y M~ <br />DAIt <br /> REQUIREMENT • <br />, ~ <br />, _ <br /> SAMPLE ~ ~ _ ~ f <br /> MEASUREMENTI <br />PERMIT -- .. -- ,. ~! ~ i:: -. .... _. _ ~: .. ~ - ~'~ - <br />REQUIREMENT _ .,. =, ^.VG ~ MX -~~ ~~ . <br />NAMEjfITLE PRINCIPAL EXECUTIVE OFFICER 1 ycrtif~ undrr penult? ntlaw lhal Ihiy dtK'amlal Y11d aII mWChmlwh »lr! TELEPHONE DATE <br />prrpured uwder m. dirrctian ar svprr~i.ian in un•ordunre »ith a eystivn deyiKned _ _- - .. - <br />to acsurc thwl q~wlified pcn~mwel praprrly ~athrr and r~ atuatr the in(urmatiun - <br />' • <br />submitted. Na.ed ~m m~ inquiry ~d lhr prrsan ur per.om »hn maaagc the ~~+trm. ~ <br />_ <br />~ <br />_ <br />__ _ _ <br />~ _ <br />'~~ ~ or lhox perumy directlp reyptm.iM! far Aathrrittg thr infurmalian, the information ` <br />~ <br />~~ <br />' .ubmitl d i., to the Ikvt o! m~ Ano»ledKe awd Ix4ief, tnN, arrunne, and campktr. SIGNATURE OF PRINCIPAL EXECUTIVE <br />~ ~ <br /> 1 am a»are that there arc yiKnirirant penaltie+ far wbmittin>; fal.e information, <br />L <br />i <br />yi <br />ti <br />i <br />t <br />h <br />t f <br />l <br />OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br />TYPED OR PRINTED ar <br />nu» <br />n~ <br />u <br />om. <br />inrluditryt the pa~s <br />biliq of fine am <br />impr <br />onnan <br />r ODE <br />COMMENTS AND EXPLAnA I Ion ur alvr vwLA 1 lures f-+ererence an anacnmenrs nere/ <br />EPA Form 3320-1 (Rev. 3'99) Previous editions may be used ;!'~O :' ? TfYIS ~S:i! ~-~:ttt 1oT[ <br />