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PERMITTEE NAME/ADDRESS (Include Facility Name/LocationijDiJjerent) <br />NAME , <br />ADDRESS L.~I'~.L:I~~ii~ f.TL7 ~;+af~~`r'L)i`; t"i:[=`,t{. <br /> <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />{~.^ ~/~ PERMIT NUMBER DISCHARGE NUMBER <br />: 1-t 1 it+i)t~l).? / ~' l1~ ... ,I fem.. wtt ., ,.. ., ac. i _.. <br />FACILITY MONITORING PERIOD <br />~. t <r ~~it ? :;, i ~~; E'~1'.l'y'(~:`~l ;= i (s ~: YEAR MO DAY YEAR MO DAY <br />LOCATION (~~t , t r ~;tij :- - - <br />.,__ I - } <br />FROM f .. TO -- ~ .:., .;..; ; <br />t f '.-{'- .. r; ~.}1 ~ 7..r ? ri ,ra 1 _ ~{ije'. _•1 t:. _F: <br />Form Approved. <br />,~,I i t )C,1C' OMB No. 2040-0004 <br />t` - ~-.6111 Cf I.- s_. ?~'~{~''I ~i ~.. <br />+ '. 17 L. t, ~ ~')l.'i.y. f. 7 :~7~7 i P t..:Iv# <br />,-- <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY <br />OF SAMPLE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ~ ANALYSIS TYPE <br />-~ t : )'-.) L~ #'. ~ •-- i s •:+.(~ <br />~.:F I u7llc?i., SAMPLE <br />MEASUREMENT i'c •#- # .: t c~ ~ -r i, c.. 3'.:....:`. u..~- #F ~..1{• # ;-. 3£ •k• <br />I;3•~t `.`" ° :' <br />' <br />` <br />. <br />EF`r'I_jJ~.!d f ~:~~~'.;~~ ilALt ij' PERMIT <br />REQUIREMENT -?i <br />###~;•# R)~I <br />~1 <br />i <br />f <br />I ^:!~'T C°(~X ~a =: <br />T.;r~t==t~ ##-fig### #ii•#### #`#°'###`if• si'x-k <br /> <br />st -r:.r .. <br /> SAMPLE <br />MEASUREMENT <br /> <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br />MEASUREMENT <br /> <br /> PERMI <br />REQUIREMENT T <br /> SAMPLE <br />MEASUREMENT <br /> <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br />MEASUREMENT <br /> <br /> PERMIT <br />REQUIREMENT <br /> A <br /> S <br />MPLE <br />MEASUREMENT <br /> '' <br />T ' <br /> PERMI <br />~,, <br />REQUIREMENT- <br /> SAMPLE <br />. MEASUREMENT <br /> <br /> PERMIT <br />REQUIREMENT <br />NAME/TITLE PRINCIPAL EX CUT VE O FFICER I certif under <br />enal <br />of law th <br />t th i <br />d <br />d <br /> y <br />p <br />ty <br />a <br />s <br />ocument an <br />all attachments were T ELEPH <br /> <br />I, <br />e <br />~ ~ <br />~ <br />prepared under my direction or supervision in accordance with a system designed ON E DATE <br /> <br />V <br />l <br />~h <br />/~ <br />~ <br />to assure that qualified personnel properly gather and evaluate the information <br />submitted. Based on my inquiry of the person or persons who manage the system, <br />or those persons directly responsible for gathering the information, the information ~ ~~~ <br />r e S J ` ~ <br />submitted is, to the best of my knowledge and belief, true, accurate, and complete. <br />SIGNATURE OF PRINCIPAL EX ~/ ~ ~~~ ~~ <br /> <br />TYPED OR PRINTED <br />I am awaze that there are significant penalties for submitting false information, ECUTIVE <br /> <br /> <br />COMMENTS AND EXPLANATION OF ANY VIOL <br />including the possibility of fine and imprisonment for knowing violations. <br />ATIONS !Reference all aftarhmumc hern- OFFICER OR AUTHORIZED AGENT AREA <br />CODE <br />NUMBER <br />YEAR <br />MO <br />DAY <br />1t.-,`ri T :~ ~' I:f~'ri~~C ~~ii'.~ i_.i t ~ :i li~_~ ~'~C. ~pt 1. YS ~..? .. . ~.-~ t~l_~l'7 ~:if-~. ::+il~v .;. ~•`7 [ .i~' ~' F•'11 }~~ LI."~ F~1~ _ =~. ;~~f i'~~ `}`•I~`}..i~ i. <br /> s:L Tl <br />.t•. _. <br />~,'ERs"4~': -c„~, Rt`ll`~! R,. C,~l "1`!_F.:-ix'!. _ <!=1~_ ~.I.~•:3 f.li')? IP; G,t„l •~%~k` r..lull:~ ~;~,'t;': ~'~'li''. ~ {.d_~.:If~' C k..~ ~ ,-~ ~I; =G i t t'' ~rrii l~, `l:f~ <br /> - <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. <br />crC? 1 7. F, G~~.~szis ~.4~a1<>~form. <br />PAGE ,~ <br />