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PERMITTEE NAMEJADDRESS:/nr(uJr F'ori(itr.\'am~/Locminn iJDiJ/rrenry <br />NAh1E r..-. ( j i• <br />. _'. H <br />FACILITY ~i~n I ~ i. ~•~' . ; , ;.:; <br />LOCATION <br />i..ANC r- ~4+~AF . "} I fdE f`1t1fVr'\t3FR <br />NATiONAI POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />DISCHARGE MONITORING REPORT (DMR) ! ' N!7R <br />~- MI <br />PERMIT NUMBER DISCHARGE NUMBER S FYI <br />.j <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY. <br />FROM TO <br />r,tnTC. o.,..a <br />Form Approved. <br />OMB No 2040-0004 <br />~~ <br />_ ._ _ <br /> <br />PARAMETER <br />QUANTITY OR LOADING -- --- ----- ..._..__.._,,,, ,,,,,,,, <br />QUALITY OR CONCENTRATION ,, ,,,,.. <br />NO. r.~...n ..... <br />fREOUENCY <br />of ..,..... <br />SAMPLE <br /> <br />AVERAGE <br />MAXIMUM <br />UNITS <br />MINIMUM <br />AVERAGE <br />MAXIMUM <br />UNITS EX ANALYSIS TYPE <br /> SAMPLE <br />MEASUREMENT <br /> r-r <br />4 <br />r • <br />-? - <br />' <br />= 'J~tiL'. PERMIT <br />:.REQUIREMENT . <br />. . ! <br />i, <br />, <br />~ ' • : I !`IFi ~ ~ ?; ~ r .. .. -x ~ a . t_ . <br /> SAMPLE <br />MEASUREMENT <br /> <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br />MEASUREMENT <br /> <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br />MEASUREMENT <br /> <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br />MEASUREMENT <br /> <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br />MEASUREMENT <br /> <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br />MEASUREMENT <br /> <br /> PERMIT <br />REQUIREMENT <br />NAMEIfITLE PRINCIPAL EXECUTIVE OFFICER I rertir) under perttll(V Of liw' lhtll Ihir dfKnment tlnd :dl tlltarhmenh were <br />prepared undrr mt direction or wpeniiun In tlreordtlnce with u y~ctem designed - <br />~-- - - --~ - -.- TELEPHONE DATE <br /> <br />- - ` - t to tliave that yuaORtd pervmnd prnperl~ Rather and cr tlluate tlw: infurmtl0un <br />rubmitted. 8tlsed on mn inquirs of U:e pa•rvm or prrs:mr whu matmRe the r~~gem, <br />or thane pennon direiMl~ rrrpundhlr for Ratherlrtg the information, the infurtmati:m i , <br />~ ~ J ~ -' <br />'~~~/ <br /> <br />_ <br />l <br />r ( i , ; 1~ rubmiltrd is. to the best of mn 6nuwiedgc tlnd hdkf. true, tlaruratc, and cnmpkte. <br />I <br />w <br />Ih <br />t <br />h <br />SIGNATURE OF PRIN <br />A _ <br />~ ~ ~( ~ 7 ~ r)G <br />'~ <br /> em a <br />aR <br />a <br />l <br />crc tlfY rt niticant <br />R pennltiea for submitting faire information, CIP <br />L EXECUTIVE - - <br />TYPED OR PRINTED <br />rnMMENTS AND FXPI ANATInN nF ANY Vlfll includirtR the purribilih of tint and Imprisatmcnt rut knuxinR c}otatiunr. <br />ATIf1NC /t?ete.e.,.-e att ~H.,..~.......... ~...,..t OFFICER OR AUTHORIZED AGENT AREA NUMBER <br />C D YEAR MO DAY <br />• - - - - --~ <br />X5;5 ?c I"~ Llhtli7'S WILL !3E i~JAVIED & SF:7TLEH: :}G <br />EPA Form 3320-I (Rev. 3/'99) Previous ediUOns may be used. <br />4HR PREi; I P EVEN i - SEE i . A Wit, <br />3U L~A'~ AVU I~ HZGH~~T f~'IOJUTHL't <br />i iu~ i. a ~ h,Irt Irian. <br />