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PERMITTEE NAME/ADDRESS tJndudr Porilrrv:~'amdLaralMn iJUiJJerrnn <br />NAME <br />ADDRESS ' <br />CU <br />FACILITY !i i,~,i_c ~. ,. LOp1rJ <br />LOCATION ;~FNCE rp <br />~RG1= V WATTERSOM. GEN <br />- spprovrc! <br />NdTIGNAL POLLUIFNT DISC HAH GE ELIMINATIOr~ SYSTEtd ((NPDESf ~d~1 F iJO. 2O4G-t~L L~,.7 <br />DISCHARGE MONITORING REPORT (DMR) <br />:it <br />PERMIT NUMBER DISCHARGE NUMBER - F I ~•le+~ FRI <br />t.... .. <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO , <br />Grt NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION Np, FREOUENCr <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE •~ <br /> MEASUREMENT <br /> PERMIT - . - r .: ., .:_ ~ ..~ . <br /> REQUIREMENT _ -I+',;. 1 ri~?f•; f'i:1i•.; :_~' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT .... ~U-R c: :r :: x~ ~ ti~ t ; <br /> <br />REQUIREMENT yt : ~.1 ;; <br />- ' <br /> SAMPLE ~ <br /> MEASUREMENT <br />' PERMIT - ~.:,.. <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT r 1' - : r t c ~ :: ~..~ .. <br /> REQUIREMENT ~ -• ~ ~ ~. ;'1 ~; r-;` '"' i ;. <br /> SAMPLE <br /> MEASUREMENT <br />' PERMIT x :~ R ~ _ ~ - .: ,.- .. ,: : r ,,.. <br /> REQUIREMENT ~ ' ''° <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE ~ <br />_. ~- <br /> <br />MEASUREMENT <br /> <br />I _ <br />_ f-=_'_~- _ <br />`-- <br /> PERMIT ~- <br />~ ~ <br /> REQUIREMENT _-~ <br />NAMElfITLE PRINCIPAL EXECUTIVE OFFICER 1 cerlifi °ne•'' pe"•'Ity nt faw that thi. d~MLlnt'nl and all nttuchmenL were _ <br />' - ' TELEPHONE DATE <br />D 1 <br />}.. <br />MU /~~ 5 Q ~ prepnrrd under m. dirrclion nr wprn ision in :wrnrtlane•r with a srstrm desi~nnl <br />to u~.ure that quuli8ed prrwnutel pn.pr rl? Knther and crahwte the inrurmyti~m :I <br />C ` r~'' -/-•~°' <br />~ 7 ~ q <br />G <br />i <br />' \` / <br />~ <br />,~ <br />/ <br />~ <br />, <br /> submitted. Na`cd .m mp inquiry ur the person or persons who manage the system. <br />or thuce pennm Directly n~gnuitdr fur gathrrinK the infwrnwtiun, the inrnrnW[lun f <br />~t, -~ rf <br />\ <br />-:'~ ~ <br />- ~ J ~~~~ ~ ~ <br />~ ~ <br />' <br />/' <br />~ <br /> <br />~. <br />~ <br />_ <br />? <br />~~ ~ 1 +ubmittrd 'n. b. the best of m? knowMdt;e and Isrlier. true. a ruruce. and iromplete. SIGNATURE OF PRINCIPAL EXECUTIVE ~. <br />r~ t <br />~~ / ~ ~ J <br />`/ ~ <br />- ~ <br />TYPED OR PRINTED I um axarc that thrrx are si>;nifwvnt pewlties fur submiuink false in(ormadon. <br />lncludin>;thew:"ibiliHuf fine andimprisonmrntlorAnowinKsiulutiwns' OFFlCER OR AUTHORIZED AGENT AREA <br />ODE NUMBER <br />YEAR <br />MO DAY <br />COMMENTS AND EXPLANATION OF ANY vIULA I furvs (Hererence an aaacnmenrs nereJ <br />t <br />EPA Form 3320-1 (Rev. 3/99) Previous editioru may t <br />)G':) 1 ~l .' (TI'lIS1l R 4-p3tt form. PAGE <br />