|
PERMITTEE NAME/ADDRESS (/ncludeFaciliryName/Location ifD~erent)
<br />NAME f r; -. .
<br />_ r ,~... ~..i ,., .~. t ~ S~i.1 (",r L_. _~~":;:41_•e .^.. ~~'S ,.~~r L_k. -.1..
<br />ADDRESS ~_.F.]hr J°: j'-!u i T~ ~ r~!(1!~'f 1;~ r''3 ). ~i ~-
<br />
<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES)
<br />DISCHARGE MONITORING REPORT (DMR)
<br />-{- PERMIT NUMBER DISCHARGE NUMBER
<br />FACILITY ~ ~' ° MONITORING PERIOD
<br />t 1 't ~ ~:_3 ,! , 1 ,t ~ -'•"t T i~..1:: YEAR MO DAY YEAR MO_ DAY
<br />LOCATIONi~3~,-.•, I ;, ~ = ~ FROM TO
<br />Form Approved..
<br />OMB No. 2040-0004
<br />rE r. raa>~
<br />ii.)3~~ F1If~ }
<br />r a .~ if) 1...1 "'r t ; t'•3 ~':1~ 3 ~ ( •srsP ~
<br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION Np, FREQUENCY
<br />OF SAMPLE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE
<br />t? d. t.... '-Sf'~=~?~;r ,.f _' -+~`
<br />Er' 3.5~SFil._ SAMPLE
<br />MEASUREMENT ~'-;c~'~-#'"#• ' ~'t~•) ~ic3i•.t'.t: =-_ iti•r. F: ~r.t:.;,. ~r. a.•,
<br />+'3~r)E:~ _t, Lj ~'
<br />~FFL.t1=::N'l' G; ;J~ 3 'JA[..~ t = PERMIT
<br />REQUIREMENT ~E•##### f~'~~';i~~''1•T'
<br />I t~ST I'~r~tX ~~~!
<br />,~_3L3 =t ##•SI•iE#3£• ###### ###•#•## ' at.•#•#•
<br />~ ;t.; .i, i r~~' CL~ I,,..iC.P L
<br /> SAMPLE
<br />MEASUREMENT
<br /> PERMIT
<br />REQUIREMENT
<br />-
<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 />REQUIREiMENT
<br /> SAMPLE
<br />MEASUREMENT
<br />
<br /> PERMIT
<br />REQUIREMENT
<br />NAME/TITLE PRINCIPAL EXEC TI E OFFICER I certify under penalty of law that this document and all attachments were ///~~~ T ELEPHON E
<br />
<br />h p v
<br />prepared under my direction or supervision in accordance with a system designed DA TE
<br />
<br />
<br />
<br />.~. ^
<br />^~~
<br />`
<br />/
<br />to assure that qualified personnel properly gather and evaluate the infotmation
<br />submitted. Based on my inquiry of [he person or persons who manage the system,
<br />or those persons directly responsible for gathering the information, the information ~~ ~~~
<br />
<br />
<br />'
<br />~~ ~
<br />/
<br />~ submitted is, to the best of my knowledge and belief, true, accurate, and complete.
<br />I SIGNATURE OF PRINCIPAL EXECUTIVE /C~
<br />~' / ~/ C~ ~(
<br />J
<br />'~ /~~
<br />I ~ O
<br />ED OR PRINTED am aware that there are significant penalties for submitting false information, 7
<br />y
<br />
<br />TYP
<br />COMMENTS AND EXPLANATION OF ANY VIOL
<br />including the possibility of fine and imprisonment for knowing violations.
<br />ATIONS /Rnfarpneu all ~+t~.~h..,nso ~,e.et QFFICER OR AUTHORIZED AGENT AREA
<br />CODE
<br />NUMBER
<br />YEAR
<br />MO
<br />DAY
<br />~" `=S I'"t ..1 , ; ,f i i ~~ . .._ ~ ~. ~. 1 ~ • : ,, jVti ~=~§ ~~ '1!' ,f .... ... . ,... '..~,., {._. ~' {fit r' ~ .~ ~' (~ r r t i tr. • i r • c ~' yj ~ r ~ :~ a t 'it
<br />Ivii~l•.f C.r.-sr+„_ ;~_ f y _a 4 r ,.. ~ t
<br />,.,.. .. r-, TRC~N ~l t"..}1L_T..i L_.~'.f -: L_/ •~7 ~.1}. Lt,r f;, I .,.t f'4 t r ~=tea" ~~. 7 ( ~ ~ .,. ~
<br />~~~~; 1 , r~", .. _ • ~. ~~ ~-r:~ .. ~ :; ~ .~ :~ , -~~- - ~~•! ~.. ~I _._3:,<<:-ry : ~ ~ _.•!r?Y?1~:IV o r~>~~i r,r
<br />EPq Form 3320-1 (Rev. 3/99) Previous editions may be used. PAGE OF
<br />ctC3 i • ... -? ~~i~s~is a..4~axt;f~rm. _..
<br />
|