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PERMITTEE NAME/ADDRESS r/nr6,dr Fori4h:Yamr/location iJl)ifJrrcnti <br />NAME <br />ADDRESS - - - <br />G <br />C:7 81 4~4 <br />FACILITY t; •~r ~; ','. i-i i •' <br />LOCATION __A ~ ~, t 424 <br />i AiVCE •:~nN, F.1i•aE MAPdA(;rEF3 <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (D R) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approves. <br />OMe No. 20ao-oooa <br />~~ <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION <br />NO. FREQUENCY <br /> <br />OF <br />SAMPLE <br /> EX SIS TYPE <br /> ANALY <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT i'~;- iy. ~ .: f: ;. .. .. ;r ... •L;-t,. i~._ . <br />• ' . REQUIREMENT - .. ~, .I : .. . s ; <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT .s•~;-it:... •~ a-~•;;u :` ~-:-;~ Fcv;: _. _ <br />. .REQUIREMENT `ri~1 T i:; "" <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ... .. -. .. ;:. ,: ;;. -- -,.. <br /> REQUIREMENT - <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT r # ~. . ~: - r•..rr i, x - <br />- <br /> REQUIREMENT I NS•T Mti X ~ <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 crrlih nndrr prnalN of law that this dacumrm um1 all utlachments were TELEPHONE DATE <br />pn•purrrt under m~ directlon nr wprn iyinn In accurdam'r with a wagm designed _ _ _ --- - --- Y.. _ <br />W mwrr that yualiecd IK nunnrl properly gather and r.aluate the intt,rmatirm <br />~~~ <br />_ ---~-- -.r--^ submiued. Na~rd m m~ inyuir• of the prru,n ur prnuns whu monagr the ~•lrm. <br />~ <br />_ <br />or thor penony directt~ respmsihk fur !<ulhering the informalinn, the information -- <br />" ~ <br />r ~ <br />% ~ <br />"t <br />~ <br />' <br />~ ~ _ <br />r <br />~ <br />..uhmiurd is. to the Mod of m~ AnuwirdQe and belief. levy. accurate. and nnnpklr. <br />. _ <br />i~'^'- <br />-. ~ <br />r <br />; ' <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br /> I um aware that them are yignirw~ant l,enal6e. for submitting lulse in(ormafiun. AREA <br /> ~lolatiom <br />fsr <br />m for knowin <br />ibilit <br />t ri <br />nd l <br />i <br />l <br />di <br />lb OFFICER OR AUTHORIZED AGENT NUMBER YEAR MO DAY <br />TYPE6 OR PRINTED g <br />. <br />c puss <br />~ n <br />M a <br />mpr <br />mme <br />nc <br />u <br />ng <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Re/erence all attachments here) <br />,. .:,. <br />.-..-~~....-. n n _~•r r_~ <br />EPA Form 3320.1 (Rev. 3J99) Previous editions may be used. ~~~.=' 9'Etis is a 4-parrforni. <br />