|
PERMITTEE NAME/ADDRESS (lncludeFaciliryName/Location if Different)
<br />NAME NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) Form Approved.
<br />L-~ :.;,Y ..,J ~'(<'JF,! . !°~z ~ ~~•; ~ ~ DISCHARGE MONITORING REPORT (DMR) ~, .OMB No 20ao-oooa
<br />ADDRESS t.,~ ~l r,.1~ iTC) r',~Pv'~° ~fi.~ ;*; tr;f
<br />J Z. Z -~ `~ ~ ~ ~ ~7 PERMIT NUMBER DISCHARGE NUMBER ~ 1 zi
<br />FACILITY d .~ ,: r ~~ ~ . ~~.C~ °,: 1"~~ +,,j ~ ~"1s- - - r , .. MONITORING ERIOD r i `, ~. . , .. _, t-~h _'t' 1' fi' ~ ~E'.i'Y'E:ifi
<br />LOCATION ~ ~ Y AR
<br />l~.iL .~ F Ctl`I ~ ~ ,?'-~;~ FRO MO DAY - -
<br />M AR MO DA + T Y I r.: T ~ '~
<br />._. .
<br />:`; (:: ;. ; _.' t r ;;~ , :1 { _y.j j ~~ `~, - . O E_rt. r: NOTE. It; ~ _. ,~+;~: ~::. !)( .}t•f ..
<br />-. I ~ '~~~~' ~ p • Read Instructions before completing this form.
<br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQ FENCY SAMPLE
<br />AVERAGE EX ANALYSIS TYPE
<br />MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS
<br />I-};[~ ?~fi`~I~ t , ,' i _. SAMPLE ~-. r- :-•:x-~x~ 'Rx" g c?-##-:~ 3~::; #':t# =•~'f# i"~'3#':'~~'2.3'
<br />~' z ~ wl~~)-- MEASUREMENT
<br />~'~~C"tom: PERMIT ~~-~t'r~'#'# R~:~I~3F~~" L~;~~=':. ~~•'~~~# :l#~'~~•'X ~'#x't~-~~' •:;~#~ •.
<br />~F"T't._UL.1~!'i t;"~.?4f t EF_I"I.LY ~`I~t.~A
<br />5 V~L.L)k. REQUIREMENT Ifi`I,~.k"1" 't'1AX fi,I~I~C= ;;•i`-;=.;
<br />SAMPLE
<br />MEASUREMENT
<br />PERMIT
<br />REQUIREMENT ,~
<br />SAMPLE
<br />MEASUREMENT
<br />PERMIT
<br />REQUIREMENT
<br />'~
<br />SAMPLE
<br />.MEASUREMENT D
<br />PERMIT
<br />REQUIREMENT
<br />SAMPLE
<br />MEASUREMENT
<br />PERMIT
<br />REQUIREMENT
<br />SAMPLE
<br />r MEASUREMENT
<br />PERMIT
<br />~ REQUIREMENT
<br />SAMPLE i
<br />MEASUREMENT
<br />PERMIT
<br />i
<br />REQUIREMENT
<br />NAME/TITLE PRINCIPAL IXECUTI E FFICER I certify under penalty of ]aw that this document and all attachments were
<br />w e ~ prepazed under my direction or supervision in accordance with a system designed TELEPHONE DATE
<br />to assure that qualified personnel properly gather and evaluate the information ~ I
<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, [he information ~ ~~ h[(/ r (p~ _a ~ '
<br />submitted is, to the best of my knowledge and belief, tme, accurate, and complete. b /~ ~ ( !r//J(y JC ~ l ^
<br />I am aware that there are significant penalties for submitting false information, SIGNATURE OF PRINCIPAL ECUTIVE
<br />TYPED OR PRINTED including the possibility of fine and imprisonment for knowing violations. OFFICER OR AUTHORIZED AGENT AREA
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) CODE NUMBER YEAR MO DAY ,
<br />_,
<br />~~'-` ^':~ ~.?'i~ }y ;., 1.,.`s~i`~~.~r`'1(~4( Via- i. ;' 1 r~t~' ~ Li...L ~:~.~' ~~,~./,~~ '~? L~1 ~ ~' L x' ~f"( ~}~: ~;ly _
<br />iTL~Ewn1~: i"t_.:.:r 1RC~31V ~, 5t_? i?._~:..zt_;_ ._,Cst_IL~~~ L1i,;. r _ .11113 _ _I ?..t... l.. .,~, ~ _ t, , -,
<br />~-' t ^ I i _ r- , h is ~ ( r
<br />_ t`' F r_.. _. 1~ lEh1 t ;:~!.. , 1~ - 7-t~ ". _,i~11~(~i :)~ (:.,;:?fi"lC;_
<br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used.
<br />t~4C?f3c %~i.7~~?j~i~ ~.4-~fl~'t~fQTril. PAGE Y OF 11
<br />.,
<br />
|