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tERMITTEE NAME/ADDRESS (IncludeFociliryNamc/LocarionifD~cren1) DAME . , ~ - ~ ~i~ max' ,~ 13. =` 1DDRESS s"'.'~~~.•:+CF~f,,} FHtic•~r:~,a`Z~~~r ~.... ... .. NATIONAL POU.UTANT DISCHARGE ELIMINATON SYSTEM (NPDES) DISCHARGE MONITORING REPORT (DMR) PERMIT NUMBER QISCHARGE NUMBER Pt•a~~I=t ~n Form Approved. OMB No. 2040-0004 {`r'i~:~'r4 ... , ~ ., ..... _...._ r ,-. ...... _ _... _ . . •`~-•= ~ MONITORING PERIOD `' ` ' ` " W -~ L•' ~ ~ ~ : :::: • . l~ \. 'AGILITY ~••>=' ; = _ YEAR MO DAY YEAR MO DAY . , w~• _ :;. , ,. _ _ ._. . _ .. _ . ) 1,•..~. i„ a ,~, .i .lip f ^ L x ~ ^ ,_. FROM yr (:`• 1 .L _ TO •._. .. ~ ~ 21 J ~' % ;'.r G i•.; ~ r;- - i w~.r.. .OCATION r. r .....- . ts ~ . a M .>,. a i :r:Y NOTE: Read Instructions before completing thPs form. . z _,•,~ __ _ __ ter... ~ .. . , ,~;-~ FREQUENCY SAMPLE NO . PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION OF TYPE IX ANALYSIS S MAXIMUM UNIT' E V E R A G A AVERAGE: MAXIMUM UNITS MINIMUM '.+'s :~`It' w .'~r.~ .'CIA .'. .. 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SAMPLE •i.: ~ ~ n #~• ~ ^ w=•~-'~- ~ # ~ ~k ~ :'.- ~ ~ /3t J f ~ J ~~ t ~ ~O Q ~ G y r r lri~ `^'' MEASUREMENT U 1V ( V .. r :.-..~ . :I~Tr~:. ...r:•1= Y A ytx:~ ~ 'x- ' ' M rs:'uJJ^^~tc5`, can r~ i ' y~tJ'~ Il 4t I w if _ _ ~yjr,/('1 rt {1 )) l>..' ( ' ~ ~' PERMIT tr$=-"•?i~:.=•~• i,'..':'r' ~ n'r+ n '~:' ., Ti ~ 11`..1 ice,: l , 1\A..1 V) . . " ` a ~ t v • .at ~ •••.•~;-k••.•w, a 5 r•. i ar kl-.•• I c•t v.? ~••P=. !... t~JS' REQUIREMENT ~ ~:. x : ~ ~'~ : ^r,r-. .+.< rl`+ ..•v:s s°~3 5-5 V s •. T) u swv e~i-: . i. r. . i 1 kn j sJ^- ., v-~i ~. { c~ ? a a: ^c.: I"SWaw 5 5 , "" `•': = SAMPLE ~: ~ ~ w•~•i; ~ r :: ~'x'„ w ~ •~'..^:..„ .~ ~ ~ r ~ J f~ 11 ~~ ~: c • MEASUREMENT ` 1 ~ , E;~~, aa:. ~ n .;.. x.;;.:r . -t: r •'k# ~• ~ •fi• r~,1...r ~e : r t~ ) ,r,,.! ?.: r ? rtilt»,.. i~ yr )1 _. ; ^: ^., ,".• •r' .._ ,.. ° ••`' i ' " ~ PERMIT REQUIREMENT ti ~ . .:. . ~Y-x ~ rwJ"tY": tY ;r ~ ._•v. (as r ~! :•~ y: \: t„t•• ).,•i=i i c r.%\ -:-•:'~ v''= ifi~i46"r.: yam . "v ~. ... : K .*J~•. ~> i~ L'..1:_n • ' . - -: i : ~ ; S :. ••:• ..~r;_ ::ak-~ SAMPLE .'..;:.. ~ x ~ .. ,...".-'~"^`' ~ ?: » }.: ~ '%" j / i ~j/ ~ `~k~ i ~•~ f ~ ~ ~ ~G -r r -+^-`• •~;~ W- _ L f3- : ' MEASUREMENT I r~II~ i . r s C~a-i~ v ..-..., ....,.. - t ~ . r.:... ~ .. { 'v .i ' ! .Jii i ~ ..; , PERMIT '=: ':, ::: '1"7~ ~ ., ~. .., .. .. _ .: 'Sv 'w. n •fi ^:: ':'".:' ~: Yii ,.jsi 'r i'~i"r ~ i .. 1 S ~ 3 :ire • „ ., ., ^ ^:1"-. r 1: • - rLa~, ':'1L 1' ~ '~ ~:.>t: :.::. a.:r •.: L•:'} ~'S v i:• a1^: 1's_'~ 5 5 Jt v5 =. =' 3 `REQUIREMENT •r ~^ ' > ' ° ' • • .: t rvL : +._ t^^~.. 5~~: ~'+r, t , - r t :=i s c• L` ~C ~ TITLE PRINCIPAL EKECUTTVE OFFICER - certify undcrpcaalty of law that this documrnt and all attachments wore AME TELEPHONE DATE N / ared under mY direction or supervision is accotdancc with a system designed re ~f'~e"~~~,f~ I ~ y L ~r r' G/M p p to aesurc that qualified pessoancl properly gather and evaluate the information s t m h th e ys e . o manage avbmitted. Based on my inquiry of tho person or persons w the information the information th i ibl f d l ~' ~ „~ or ga ec ag . y tc~pans c vxt or those pcrsorw t l }~f ~,/ Q ~~ ~ ~~ ~ ~ ~ ~ ^ ~• G e. c submitted is, to the best of my 3mowlcdgc and belief true, accumta and aomP SIGNATURE OF CIPAL CUTIVE 1 (' ` • ~ i ~ 1G ( I am aware that there arc sigmftcant pcoalticw for submitting t3lse information. OFFICER OR AUTHORIZED AGENT EA viol tions f l i ri CODE NUMBER YEAR MO DAY TYPED OR PRINTED a . or mow ag sonment including the po~ibility of fine and imp COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference a!f attachments here) EPA Form 3320-1 (Rev. 3/99) Previous edlUons may be used. rJ,~~Q~:~~ J"_"'~~'Z-4`` fpm, PAGE s~ OF