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PERMITTEE NAME/ADDRESS (IncludeFaciliryName/LocationifD~erent) <br />NAME <br />ADDRESS ~.~ ~:`"?~ i`~~':.i. f ~ CF~iI~l~'I~!~! {~'i . ;'. <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />. -re .. t ~ ' r: t"-1i:.~ ~-~ ~~ _~ s_ ..1':x..^ +,~} i ",' MONITORING PERIOD <br />FACILITY , i ,. L..l L ~,.-~ ; • <br />LOCATION,.., t ~ YEAR MO DAY YEAR MO DAY <br />fwt~.._; _~.. ~n c: ~`'r: FROM t.: 1. 1'O t., . _.~ < <br />Form Approved. <br />OMB No. 2040-0004 <br />t~1 I' C!ClF ; <br />.-.- ,.. L i~. } <br /> <br />IJATF• Qned Ins+.. n+:n o +.nf.. ..le.+:.... +:.:~. f....« <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY SAMPLE <br /> <br />EX OF <br /> ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />~.... , .,I,(i.i =.7? . ~ _.-r:_, t= SAMPLE t;..::~ .t• •ti^7"r r ~~ .' -~ -•?: ~: <br />is 'tc •~ •}: •3~^!••~'i:~. •;r ~.ti.:,>..I4 .t~. <br />V Z ~l.}t~ti . MEASUREMENT <br />E3'+~;:)t<•;' .`. ,'=? PERMIT •#-#~•~3ri~3P R~F'C1~"~ ~:.;= ? 3#i#~##~iz •~3~3F•3i•31~~ 3r#~*•~•~~ ~~-k~. ~F~r{i_`t d.i~t.;F'~E <br />Ear !.l ~r»~ r t:>`-i_l5`a `v'~tLL.7~• REQUIREMENT i1~i~a-E' ~'E#~+X {'?i=- .:, <br />,:. <br />. ,- ~-.. ~. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE C <br /> MEASUREMENT ~'J <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUT OFFICER I certify under penalty of law that this document and all attachments were T ELEPHON E DATE <br />@@~J"" <br />~/~ ~ C©(f P ~~ prepared under my direction or supervision in accordance with a system designed <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 /> <br />r~~s submitted is, to the best of my knowledge and belief, true, accurate, and complete. <br />I <br />h <br />h <br />i <br />if SIGNATURE OF PRINCIPAL ECUTIVE <br />~i~ <br />s~ ~ <br />1/ <br /> am aware [ <br />at t <br />ere aze s <br />gn <br />icant penalties for submitting false information, <br />TYPED OR PRINTED including the possibility of fine and imprisonment for knowing violations. OFFICER OR AUTHORIZED AGENT AREA NUMBER YEAR O DAY <br />nn^A^wewlTe• wwln GVOI A4IATIALI AC ALIV \/IAI ATIAI"IC /e~s_..____ _ CODE _. <br />Y L~._~i 7. ~_.. ..ft` .- 1-T~'`-.. ,filet::: i:~t_ S.._Lr"i T"} WLt.. :?i_. N~/~1~Zr~L._ i., ~:I t~~l... f'I L7 ~.1.~ ~~_t~_~I~"~ ...... ~~,1`.l ~~r _.... .C. j-t ~7._r" _ t. .. "1 <br /> ,. .'GTI''i' ~~~'.t. ~. Pt <br />. --~ 3. t~k..~7 ~1 l{ ~' z i : }_.~h'11.)k_1 i.J ~.~+f. li 1•_.: 4.. - !:~ i ~~ l.:i ~4~Ft ~_i..: ~ L.i i~ _ ._ _ :: t~, E "1 1i j. _.s~.t ~ ~• _ i._ ..} t _ <br />i. c <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. gyp,., ; ,_, `_ .; L y , ~ ~ ,` - <br />s ;.~ rs7i~14Stt9' $ ~ fDT'111. PAGE OF <br />