|
PERMITTEE NAME/ADDRESS (Include Facility Name/LocationifD~erent)
<br />NAME ,
<br />t~
<br />ADDRESS :...l.e..n..~s%, ~: T'~ ~~i~s~~Y{~V1, h'i ,~.
<br />,• ~• ~.
<br />FACILITY f_~, .; .. i. ' tJ Cr";~.?'~' r ~i ~~i .i ;"_
<br />LOCATION ~.~~ a~ 1 ' ;l'+ W .
<br />`~,~:• ,.
<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 ,. n; : 1 TO :. < ~ :.,~
<br />Form Approved.
<br />OMB No. 2040-0004
<br />#YI X dpi ~? ~
<br />„ : i~'?,' ,fit' ,f-r i'<~~~ ; ~ ? .s£•i~:~ ,.
<br />~tnTC. o...,d t .................. ~s,._..
<br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY
<br />OF SAMPLE
<br />
<br />(..
<br />i`. i~
<br />~'
<br />c~ AVERAGE
<br />` MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE
<br />. :
<br />,
<br />S
<br />~' ~. `.-s-`Cz{~.1-. SAMPLE
<br />MEASUREMENT ~
<br />: ~.^ i~'1c ~-~ ( ''a7 ~' ` -e:#~: ~ r =N' f.:.- i~ ~r~ :^ ~r -T•~_-~i•~=:3',.~
<br />;:'S~
<br />ii~ :
<br />~ ;_; '
<br />~ I
<br />.'
<br />"
<br />r.
<br />:
<br />~F~I..~1~.~ : ~'•;`."J~~ti ~It'~(...(1_. PERMIT
<br />REQUIREMENT •~•#•~Y3
<br />c•}
<br />,# R~:F
<br />#.J~t
<br />I
<br />I i~1,r"-.s'?' ~It-~?ii ' I=.`S~=Y
<br />r.,)r'.'=fit it-#i~#~~ ~##~•#••at- #'st•#•~#~
<br />
<br />f: .. "_%e {{ aa l y~ J{,
<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 />
<br /> SAMPLE
<br />MEASUREMENT
<br />
<br /> PERMIT
<br />REQUIREMENT
<br />
<br /> SAMPLE
<br />MEASUREMENT
<br />
<br /> PERMIT
<br />REQUIREMENT
<br /> SAMP
<br /> LE
<br />MEASUREMENT
<br />
<br /> PERMIT
<br />REQUIREMENT
<br />N /TITLE PRINCIPAL EXECUTIVE O F ICER 1 certif under
<br />enal
<br />of l
<br />th
<br />t th i
<br />d
<br /> y
<br />p
<br />ty
<br />aw
<br />a
<br />s
<br />ocument and ail attachments were T ELEP
<br />
<br />"
<br />prepared under my direction or supervision in accordance with a system designed HON E DA TE
<br />
<br />~,,,_
<br />U uP . '
<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 [hose persons directly responsible for gathering the information, the information ~~
<br />
<br />submitted is, to the best of my knowledge and belief, true, accurate, and complete.
<br />SIGNATURE OF PRINCIPAL E ~~~ ~ ` ~~ ~ ~ /~
<br />
<br />TYPED OR PRINTED
<br />I am aware that there aze significant penalties for submitting false information, XECUTIVE
<br />OF
<br />
<br />
<br />COMMENTS AND EXPLANATION OF ANY VIOL
<br />including the possibility of fine and imprisonment for knowing violations.
<br />ATIONS (Reference all attachmantc haro- FICER OR AUTHORIZED AGENT AREA
<br />CODE NUMBER
<br />YEAR
<br />O
<br />DAY
<br />+ ,_: r
<br />,,,, f; ~ ~ r',,; t,ii-:~' r I'~ iixy~~ '~ -: t^)Ft f~1:. ~.: ~,1 ~ 1 i_~'A?3LF- tt~t ,?, L..i~.'~ . ; -~~;... x=~} ~r *;` " `5~ '~ `Ir
<br />~i _ ~ ~
<br />-. ~ [ A
<br />,.
<br />e `
<br />t~'.S3'f !'i-~d ~ :", 1RJt~1 q: ~~LT T._i;.~3.,' .. _,~??..i±:~^- 4 .i: i"!'z. Ir'~i ~;i=i: r-(;€t ~ ? t ~-~ ~a.:-;I~, r.:_ _: r-:~; ~ ~ J fi°~ .. ~ r ~. ~ .,
<br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. ~~. ~ r_~~, i E',~~tiS?i9 .~.~~~pirn. PAGE _y OF
<br />r_..
<br />
|