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' PERMITTEE NAME,ADDRESS ILIClude•Fucilin :\'ume~Lueuti.m 1fUi/frrrn» <br />NAME <br />ADDRESS -~'+r <br />I f•GTGfV !f ''f 4051 <br />FACILITY ~ ~ ! ~ !'I T I~11. <br />LOCATION _':,-!GP.I l-;~ $? "~- <br />UCF ADT; if'.iGTUr~, +JWNER <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 />Form Approved- <br />OMB No. 2040-U004 <br />REf U5E AP.,Fr~ PuND T^ PURGA~ <br />N(1TF• Liwarl Incfnlr•Hnnc hnlnrA nmm~lufinn this form <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREDUENCY SAMPLE <br /> <br />EX OF <br />TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ANALYSIS <br /> SAMPLE - -< +'-#Yt- +~ r- . . <br /> MEASUREMENT <br /> PERMIT x x- # '•-tt :: !cif#'.r# 1 _ t: Y .. <br />`~ t- ~ <br />- REQUIREMENT = s- , " '•? ~ ^' <br />19F}X .i fi1L3hi <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~-i s: r=# #I: t~•~•#x- >;• st s- .. ..:. # =T5 ~ t VC! .t-;4 <br />i •?. REQUIREMENT .~i:r~rri =1''r G FI:~ ! D f-i`~ i•i': f'iOh1TF-i <br /> SAMPLE , :: - ::. - ~ _ <br /> MEASUREMENT <br /> PERMIT # :- Ir r. •!;•.~• it k ~ :, - r- :~ . i% ~ `, •- _ ~ ,.. <br />- REQUIREMENT ., ~,; TN", .1 L Y' i"i~' I'iC~P•ITi-' <br /> SAMPLE - ---1 rt • <br />G: , <br />_ MEASUREMENT . <br />I J <br />. PERMIT .. - +.### y,•. t= -~ rs- ## it . 1. '-, -: ,.rj ~ <br />_ REQUIREMENT _~ - 3•'~+DP, AVM' DAILY h1X i'!": 1•TCit\7';-i <br /> SAMPLE t :~ -. .... - ;- .,- , t <br /> MEASUREMENT <br /> PERMIT ~±:,~,~•~.# #~--iF~## # # :; ##•ii• •>:F# •~-~•~•ff ~# ~ . <br />.-., `/iii-tJ; REQUIREMENT •. -. .=-r i'fr;`. :!:_ GEf`JT <br />j SAMPLE ( O ) :: +z t: ~- i~ ;i <br />~~;_:; : i•:~NT PL_! i ; MEASUREMENT <br />• ~ ~ PERMIT ~ P OR ;.. ` ._ , . . ~ ..: # ~.,. ~. i , , <br /> REQUIREMENT - .A AVL-; '".; ~ ; ,. : .- <br /> SAMPLE ii i9'r # y 1 ~ ..:... <br /> MEASUREMENT <br /> PERMIT ,. t~ l' - --i 1EiEiE-ttFr.' .-~Ar-~•# .. .. ..•~••~ - +._,:. _Y ! :.cir•~ <br /> REQUIREMENT 1 fV~'.T i`4AX - <br />NAME/TITLE PRINCIPAL EXECUTIVEAFFICER I enuj under penal[` of Iaw that this dxumcrtt and all attachments wcrc <br />r <br />~~ TELEPHONE DATE <br />~!j / I? ~'' ~ ~ . (= r I' ~-"'~ ~'~ ~ C pnpar.i under my dirccfion or supers~ision m accordance with a system designc~i <br />to assure thv quahficd personnel ptapcrly Bathe, and esalu:ltr the information ~~/7 /. <br />' <br />~~ <br />U' ~ - ~t subrnrtted Nt~srd on my inywr} of the person nr per~rtc wha manage nc~ syst<~m /I / <br />/ <br />,~~' Q ' ((// 1 ~~''~~~~ <br />r <br />, <br />J <br />' . <br />or those pcrsaas directly re:pl.mstble for gutrennc the tnfcKmnrion. the intitrmauon r. <br />_ <br />- / <br />i <br />r <br />~ / r } <br />submnud is. u. nc~ best of my knowledge and bdtef. we. accurate, and wmplenr <br />I r <br />h <br />t th <br />ifi <br />i <br />l <br />f <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />~~ ~ ~ ~~: ~ ,y <br />` <br />/ <br />(/ `' <br />~! <br /> , ,pro t <br />a <br />ere are s <br />ties <br />gn <br />cant pena <br />or submitting false information, <br /> <br />TYPED OR PRINTED <br />_._u.br ~; mr pusibility of fine and imprix,nutcnt for knosvmg violations' OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YE R <br />MO D Y <br /> CODE <br />............... ... .-..... ~... ~.-....-...v.. v. .~... ..v v...v...a tote crcnl.c on au <br />EPA Form 3320-1 (Rev. 3;'99) Previous editions may <br />OI.I I/I/CIIrJ /IC/C~ <br />~O-~D RE~OP.I•FD. C)? L °< ~..^R~ASE - °EE I t~. l . D. P `~ T55 gc <br />_ ~ <br />'1'}-ice ? ,, ~-~ -. ,.~ ~ PAGE OF <br />