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PERMITTEE NAMElADDRESS Narlude F'arifify.\'ante/Lxarion if Drffinntl RATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />NAME ~,~ Ir-r . DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS ~ ~ ~ • - <br />{ i PERMIT NUMBER DISCHARGE NUMBER <br />FACILm `;; ~ Z171y ; ; I ~.;~ MONITORING PERIOD <br />LOCATION ; , q ,_ 7 f _ YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved. <br />OMB No. 2040-0004 <br />JF T3RT~t~ Tt7 TU7~ <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING DUALITY OR CONCENTRATION N~, FREDUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE ' <br /> MEASUREMENT <br /> PERMIT .. , ~ _ <br />J REQUIREMENT `') ~ l' '•~,-.`; 1 t~il.ii s , <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT y , :r .., :.., :~ .~ <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT r ~ _..._ -, ,t ...., ., <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT :> - K r: +.. -, . <br /> REQUIREMENT `;=F' :;~,'`; <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT -, ., -> ..r•sr <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT .. .r .. _ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ ` ,Jr, .. r -. ~ .. -. - -. ,.. .. _ ~ ~ . <br /> :REQUIREMENT + , ~ti ~ ;':~ '.)r ~ ' i_ `; - <br />NAME/TiTLE PRINCIPAL EXECUTIVE OFFICER I reni!) under penalK of luw that thi. du,vmrnt and all uuarhment+ were <br />f <br />ith <br />d <br />d <br />du <br />i <br />• <br />i <br />i <br />d <br />• <br />t <br />d <br />i <br />d TELEPHONE DATE <br /> on or wp< <br />ra <br />e <br />a rs <br />prrpon <br />un <br />er m. <br />rat <br />s <br />on <br />n acarc <br />ann <br />em <br />ea <br />{tne __ " <br />" -~~` <br />' <br /> to x<wre that yualiried prnonMl properly pulhrr anJ ca aiuote the infnrmnUoa " <br />" <br /> wbmittrd. Ba.ed on my inquiry of the pawn or pawn. who ma,wgt Ilrc arctnn. q _ i _- <br />- or thane perwn_s dirertl~ responsibk for ipthrri„R ihr information, the information ~----~ <br />. <br />,, auhmittrd h, to q,r fx~t .d m. kw,.al dge and tw•Itrr, true. acruratr_ and compkts. "~ <br />. <br />, it <br />ti <br />I <br />h <br />t th <br />i <br />ifk <br />m <br />l <br />i <br />f <br />h <br />i <br />f <br />k <br />i <br />f SIGNATURE OF PRINCIPAL EXECUTIVE ' <br /> <br />• TYPED. R PRINTED e. <br />n>; <br />orma <br />on' <br />am aware t <br />a <br />ere are a <br />gn <br />x <br />pena <br />t <br />or w <br />m <br />t <br />a <br />e <br />n <br />i,xludin{; the po.,ihililr o! fine and impriwnmem for km:wing aiolaGon.. <br />OFFICER OR AUTHORIZED AGENT AREA <br />CODE NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS vtlvu txr~AlvAlwn ur ArvT vluLPtllun~ (nererence an arracnmenrs nere~ <br />L. Li <br />EPA Form 3320-t (Rev. 3.'99) Previous editions may be used. <br />115 ~S if ~-11£ITt f~6['nl. PAGE OF <br />