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I'ERMITTEE NAME/ADDRESS(I,ri~LF.eiNryN../Locu/owl/D~pfi.,,,,r) <br />NAME <br />AppgESS <br />_ ... ~.._.. ._Cf;.,, <br />. b0>. 14 3U <br />• ~~l~E ~:G al~lb <br />FACwTV ;51U;: hOtITM t: SL;U1'h hl c~t5 <br />Loa-TyoN EA:.t~31c CV b],516 <br />,• <br />Form Approved <br />NATIONAL f+OLIUTANT DISCHMOE ELIMINATION SYSTQt /rNPDES/ Ory1B NO. 2040-0004 <br />DISCHARGE MONITORINQ REPORT (DMRI <br />' 1. ~~ <br />PERMIT NUMBER ascHMOE NUMBER _ ~ ; ., n i C c. ~ A <br />MONITORING PERIOD ~ ~ r, <br />YEAR MO DAY YEAR MO DAY _ <br />FROM TO -•--- - ~.. ` ` .` .. : ' _ ~ ~~ .. <br /> <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FaEU~ufNCr SAMPLE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX '~t~~~s TYPE <br /> SAMPLE <br />MEASUR <br />' <br /> EMENT <br /> PERMIT <br /> <br />REQUIREMENT <br />~ ~ <br />~ ' ;' i Y <br />" - ' <br /> <br /> SAMPLE i <br /> MEASUREMENT <br /> PERMIT <br /> - , , ~ , <br /> <br />REQUIREMENT ,, I, t. < ~ .. ~ :_ <br /> ,. , _ <br />.. ~ SAMPLE ( <br />{ <br />' <br /> MEASUREMENT <br /> PERMIT ~ <br />.. <br /> ,, <br />: .., . i' r G - T :~ ~ F ~ F ~ <br /> <br />. ... j •, <br />REQUIREMENT . <br /> i ;. i 1 Y ~ _~ :. ~ h 1 h <br />_ SAMPLE <br />t <br /> MEASUREMENT <br /> PERMIT r : <br />>pr <br />~ <br />• ~ . <br />,. .., :, <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />_ REQUIREMENT ' ' " ' <br /> <br />_. , n ~ . ,. SAMPLE ~ <br />., ;. _ MEASUREMENT <br /> PERMIT f <br />& ~ <br />- <br />_ ~ . , ... <br />REQUIREMENT ~T <br />ttv <br />~ ~ v n i <br />r . <br />: ..F <br />;:.~ <br />~ 't :' <br />~ ~ rLti :D_,_r` <br /> . <br />. . <br />, <br />_ ~• L SAMPLE <br /> MEASUREMENT ~ <br /> PERMIT • <br /> <br />REQUIREMENT r i.' :• <br />' :•.. <br />t C F ~ f i r.:. <br /> i !1 n <br />r ~ "' <br />.ir <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER t `~n'tr tl er pens ,] o lew m.t uy <br />prep..ed tlnder itl <br />direcllon or <br />u <br />er e«vrrKm .nd w ^„«h~tltf wrre <br />ehl <br />I TELEPHON <br /> <br /> <br />•-~--- <br />] <br />f <br />p <br />on <br />n .rtordence w{Ih a f]lfem OdEned <br />ttl lWYre u.t <br />tleNfled <br />ersonnel <br />ro <br />A <br /> <br />~ E <br />DATE <br />~ (~ 1'. ' ~ ;" g <br />p <br />p <br />pe <br />] Eelher end e•ehrelr the Informetton <br />+b <br />ltt <br />6 ~ <br />~ w <br />m <br />rd. <br />sned on m] Irpulry o/ tht perwn or penwr who rrun.~e the syftem, <br /> <br />--- or lhoee persom dlrertl] rnporM ble for E^1hMrK ue Inforsnstlen, the Infor•rrftbn <br />wbudlted Is, to ue best M mr knowled <br />e . <br />d A <br />M <br />f _ <br />~ <br /> E <br />n <br />e <br />r <br />, Iroe, ^ccu ra,e, end compkle. <br />1 ^rn .were uel (here ere d <br />dM1cinl <br />e <br />Itb f <br />-- ~ ~ <br />~ <br />~ ~~ <br /> <br />ED OR PRINTED E <br />n^ <br />p <br />or submlltlnE f^ler Intonrutlon, <br />I <br />l <br />l EIONATURE OF IRINCMAI EXECUTEVE ~ <br />TYP nc <br />ud <br />n~ Ihr pofrdbllll] of floe end Imprhonment for -no.ln~ •IdeUgfi OFFICER OR AUTHORIZED AGENT A '~ NUMEfER <br />YEAR <br />M <br />r.()MMENTS AND EXPLANATION OF ANY VIOL ATIONS t{7.~...n~../t ....n/f.•f.we. A_._l CODE O OAY <br />~:,. ~.it.i.~. F~)!1 r1 :.1tR~tA':E LI" <br />• ZT~~°t~'!~~ .~3L'r, lt~v~ , <br />_ . <br /> <br />EPA Form 3320.7 (Rev. 3/99) Previous editions maybe used. <br />F'. EYFHT CCCVr.S~ :::~JtC <br />.~~ <br />~3-part form PAGE pF <br />