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PERMITTEE NAME/ADDRESS sfndude Fori(iry .Vamr//,uratiun if Different! <br />NAME r ... _ ~. <br />ADDRESS ~'7 i ~ ,; r <br />X r• <br />CCl 6I4~4 <br />FACILITY _ f 10f'3 I ZI.+`'~ ~'1 ~ I~l~ <br />LOCATION _A ~ r (j ~ Z 4~4 <br />L.ANICE ~~~=~DE~ -''(IN~ MAM1IAE~ER <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 />F - FIhlAL <br />SR&C1IfvE DRNG TRIG Tt <br />~~ <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANAt.rsls <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - FiE'r7RT -: DR7 ~~ . <br />~., J REQUIREMENT 3CiDA iH~h - ! i;: <br /> SAMPLE <br />_ MEASUREMENT <br />'„ PERM17 - :-i!•~r-tr i:x sr t.. :--tr ~?C;:'taR i ~ ~~-`i.)ir- <br />~.. REQUIREMENT ' ;3:,iDA ~` `~ ~ `~°, ; t `: <br />`_ `_ SAMPLE <br />~~ ~ • MEASUREMENT <br /> PERMIT - .: -t,;,-.v. , z~-;`~. x ~Y~:: st7r,, : -; C"i7R " <br /> REQUIREMENT :: ;~ L'A A'Y to ~;;~ i t Y <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/TfTLE PRINCIPAL EXECUTIVE OFFICER I ca•rtiq under prnaln ~A law that this d,KUmrns uml all astaahmrnls wrrc TELEPHONE <br />ra i+ia~ in uccordatur with a sstrm de+i <br />re <br />urrd under ms dirrrtion ur su <br />md DATE <br /> p <br />p <br />p <br />y <br />~ <br /> so aisurr Itwt qualifiad pcrwond proprrly ttashrr and es aluale the information - - - <br />_ <br />.-_ <br />- <br />- submitted. Based on m~ inyuiry ~.! she pa•rv~n nr prr~ms whu manaRr the y+trm• ~' ~+ t <br />~ <br />-- <br />- ' <br />• <br />- or Ihosv prrWms diredl~ rc+p~m+ible for gashrrin>; the inrnrmauun. tM• inrormsttlon ~ - <br />_ <br />s <br />su the b <br />st of ms Atwwird <br />e and belief <br />srue <br />accurate <br />and rom <br />kta <br />b <br />itted is <br />; <br />., <br />.- K <br />. <br />p <br />u <br />m <br />, <br />e <br />, <br />, <br />SIGNATURE OF PRINCIPAL EXECUTIVE ~ ~ <br />- <br /> I xm aware that there an• signifiavm penaltin for wbmiuing fuLe information, <br /> <br />TYPED O PRINTED OFFICER OR AUTHORIZED AGENT AREA <br />includink sbr possibility of fine and imprisonmem for 1.nowinQ violations. CODE NUMBER YEAR MQ DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />PAGE OF <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. - ' ~?~} ' `-~iS I~ D ~-p314 lcml~• <br />