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PERMITTEE NAME/ADDRESS (Include Facility Name/Location ijD~erent) <br />NAME NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) Form Approved. <br />9--~' L <'. --!"f.) '"r'fF-;i_ r ""'' t '~i`{; („-f_ (^ DISCHARGE MONITORING REPORT (DMR) OMB No. 2040-0004 <br />ADDRESS [ ' ~ r " I .p,:. !~ I ~~~ <br />,.1 ~ •d ITJ t.eyt\lY~I., ~f t.,._. I, .;.~;'-, ,:~._,~. ~` I'~7 r•~ r c I ~;z;:. <br />~Z~ ^~-' ` r'~ .Uu-u('':T`'~ ' " ` t- PERMIT NUMBER DISCHARGE NUMBER ~- ~t r• I ~~ <br />i (: r!-~ ~ ~ir Y1i ~~rJ / . s...._ ,` r ` $ t"~.41'~{/`4[t. _„;~~~°~eT.'S . <br /> AGILITY <br />LOCATIONltIA ~tT w1,F <br /> <br />~..I...i..; ;. ,_. ' ~ x l) ~ tl <br />~ <br /> <br />t ~f r ~ <br /> <br /> <br /> <br />., <br />l ~:i <br />1. .t <br />'~ ti;,.~i..~ <br />FRO <br /> <br /> <br /> <br />M MONITORING PERIOD <br /> <br /> <br /> <br /> <br />D MO <br />MO AY EAR DAY <br />.... ;~. ,, <br />.._ .._ <br />~ TO Y ~.. ~s ~} ~ ` i~i~'"•=~~ 7~ JI:~~'~ <br /> <br /> <br /> <br /> <br /> <br />i. <br />~~: I'( <br />: rl _ .~t'7!~ii~t~:L <br />N ~.6=,1•~ <br /> <br />~_~ <br />i~- l~Yi~~l <br /> <br /> <br />°" i~••t~ 3t• <br /> <br />PARAMETER R <br />OTE: ead Instructions bef ore co mpleting th is form. <br /> <br />` QUAN TITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> <br />AVERAGE <br />MAXIMUM <br />UNITS <br />MINIMUM <br /> <br />AVERAGE <br /> <br />MAXIMUM <br />EX OF <br />ANALYSIS <br />TYPE <br /> <br />i:~ T i. C-a('l ~ i~~~' <br />!- I:: <br />'° UNITS <br /> . <br />~~ ~ ~~ ~E-• SAMPLE <br />MEASUREMENT -,t x..~t. r: ~<. ~i~~ ' -~ •i~ ::-?~ :~ :~• ;' ; K; _ <br /> E~~~st c~ 1. PERMIT iFt~~°•~•3t F4~F't?t~"#" ]r`ro'~= E#•3F#i#•~ <br /> <br />I;i" I'~I-.~~i01 i t`a l`'.r.J,.~~ `dA'iLUf <br />REQUIREMENT <br />r• // u.. -r. ~y,s~ y <br />.a. P~~w,i i i ii'IA . <br />~-•~ <br />i°~j'.-!:'y,t 3t3t•~•3t••it# #•~~it~st•~ a~~• <br /> <br /> <br />: <br />t <br />' <br />~~1~,c..Y <br />' I`~-r. UAL. <br /> <br />SAMPLE . <br />: <br />i.. <br /> MEASUREMENT <br /> PERMIT - <br /> REQUIREMENT <br />' SAMPLE <br /> MEASUREMENT Q- <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> <br />I MEASUREMENT <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 /> PE <br /> RMIT <br /> REQUIREMENT <br /> NAME/TITLE PRINCIPAL EXE UTI E O FFICER I certify under penalty of law that this document and alt attachments were <br /> ~,/ y~ ~Q. <br />/j J, / ~ prepared under my direction or supervision in accordance with a system designed <br />to assure that qualified personnel properl <br />ather and <br />l <br />h /~ - T ELEPHON E DAT E <br /> <br />(/ <br />/ir <br />~ y g <br />eva <br />uate t <br />e mfonnation <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 <br />th <br />i <br />f <br />i C~ <br />/~/ <br />i <br /> <br />e /, <br />~ ~ <br />S ~ v , <br />e <br />n <br />ormat <br />on <br />submitted is <br />to the best of m <br />k <br />l <br />d <br /> <br />\ <br />, <br />y <br />now <br />e <br />ge and belief, true, accurate, and complete. <br />I am aware that there are significant <br />enalties f <br />b <br />i <br />i <br />f <br /> <br />SIGNATURE OF PRINCIPAL E <br /> <br />~ _ <br /> <br />~~ ~~ <br /> <br />~ <br /> <br />~~ <br /> TYPED OR PRINTED p <br />or su <br />m <br />tt <br />ng <br />alse information, <br />including the possibility of fine and imprisonment for knowing violations ECUTIVE <br />OFFICER OR AUTHORIZED AGENT A <br /> <br />COMMENTS AND EXPLANATION OF ANY VIOL . <br />ATIONS (Reference all attachments here) REA <br />CODE <br />NUMBER <br />YEAR <br />MO <br />DAY <br />c„ ° s=: ~: ;..: ',~ s ~ ,~ , ~ L EIS W4I V~,- `; t ! ~fl l ~`_ <br />1 1- <br />I ~ ?I~ <br />L <br />r <br />, <br />~ <br />~~ <br />~ <br />~ ~" : ~'~~i ! ~, ~'~: T ~. f~~! ~a C'b L_ (• ~I F.. /-i ~. ;_. ~.. ~1!_ ~.r`.] .L l~t_. ...) ~~.J t`5 ,. ~t,F.:. _. ~ ..~ <br />TI L ' <br /> <br />~ <br /> <br />,. <br />,JY - .(. ~ ... _, <br />; L ..: <br />.r ~ <br />._ I -.I <br />: <br />. t <br />`t <br />i: ~ ~. ~" <br />_ . ; <br />. ~ ~ <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. <br /> Oi:1'.,l ~"~' i ~~' ~~1'1S; 19 #1.~-~)~-~~f®I1ri. PAGE _ OF <br />