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PERMITTEE NAME/ADDRESS Ilnrlndr FariGtr .Yamdl.riration iJlhJ/errnt, <br />NAME <br />ADDRESS ~ I`1 T ME <br />i f+iV-+<. <br />FAC1uTY ~; M ~ ~; ; <br />LOCATION •~ a ~ L k'•. <br /> <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 />( ~I <br />~ ' <br />vii <br />NOTE: Read Instructions before completing this form. <br /> <br />NO FREQUENCY <br />SAMPLE <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION . <br />EX of <br />ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />MEASUREMENT ~ ~ ,- f . ~- ,~ ~ /.~ 1t~1 `~ I T I <br /> <br /> - <br /> PERMIT I`I : f~' •. ' Mi 17`I r't~PtTH <br /> REQUIREMENT <br /> SAMPLE _ ~ = l , -- i`_,'~1f?. <br /> MEASUREMENT <br /> . .~~t~ <br /> PERMIT .: _ ~ ~ ;. I <br /> REQUIREMENT a <br /> SAMPLE k /` , ~; _ _ `_ ~ F7~~ <br /> MEASUREMENT <br /> <br /> PERMIT <br />~ <br />l~ <br />t .• I`I i <br />~'I ~- <br /> REQUIREMENT :~ ` <br /> SAMPLE ~ 14~~ .mil ~} /.~ ~ - L ,1 ~; <br /> MEASUREMENT <br /> <br />t _ <br />... _ _; <br /> PERMIT r ^ ., •~ <br />~ ..1. , ~ ~ T f ' <br /> REQUIREMENT <br /> <br />SAMPLE <br />~ J <br />I ._ _ <br />' ~ ~ <br />~. <br />_ <br />~ /_.: r-~. <br />~ ; . -- <br />~ 1 Yom, <br /> MEASUREMENT <br /> ~ ~~. ., , . <br /> PERMIT ;r .4 w <br />. , <br />;)r=1Il..~ti' I":~: t : i n <br /> REQUIREMENT <br /> SAMPLE :~ /; r..;1 ,1 rl l.~ <br /> MEASUREMENT <br /> <br /> „. ' <br /> REQUIREMENT <br /> SAMPLE - I ~ I ~~ I~ `~T' <br /> MEASUREMENT tJ. <br />• I I C%. ~ ~ <br /> <br /> PERMIT ' <br /> REQUIREMENT <br />TITLE PRINCIPAL EXECUTIVE OFFICER I .ertiry nndrr (K•nau) .,r IuN mat mi. d~wunxnt and ull attachmrnl~ wrre . - `~ ~! ~ <br />`~ <br />~ TELEPHONE DATE <br />NAME/ prrparrd under m. direitino ..r ,upeni.ion In aarunlance »ith a .y trm tk.iµned ~ ~c <br />r <br /> m a.wre that qualiRed prrunnrl pmperk µutM•r and r~ahtxte the Inronnation <br />h <br />t _ ,.~-" ~ ~ <br />Y ~ " <br />/~- <br />• - e c~s <br />em. <br />.ubmittrd. 14tvd un m~ mquin of the prrvm nr prrum. efio manaµe t ~ . <br /> the information <br />ptherinµ the mrormulion <br />hk (nr <br />th n <br />s <br />di __ " ~ ~ <br />~ < <br />, % S <br />-- <br />~ ~ <br />~ . <br />µ <br />nY <br />~gw <br />t <br />or th.nr prrMms <br />wbmittrd iti, to the Iw•N of my knoe ledµe and M•her, 1r1M. nccurntq and rnmpkte. <br /> <br />SIGNATURE OF PRINCIPAL EXECUTIVE , ~ <br />. <br />~. v 1~ <br />-~ '-y i Y <br />.- •_ i~ ~~ <br />~~ < <'-"~ ~~~~ I um aw•rrr that there an~ •ignirirrnt prnultic. for cuhmitling falx informauun. OFFICER OR AUTHORIZED AGENT AREA NUMBER YEAR MO DAY <br />TYPED OR PRINTED includinK the p.n.ihiliq of fine and impriwutment for 6rtnwinµ ~iolutimt+. <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />` EPA Form 3320-t (Rev. 3199) Previous editions may Ge used <br />