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PERMITTEE NAME/ADDRESS (Include Facility Name/Location ifD~erent) NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDE$) Form Approved. <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />{ 3L'`3 "~~ t'r;`, ",` 3~t„;`: +_i._t'. OMB No. 2040-0004 <br />t; <br />r"17. f`.IUR <br />ADDRESS 1, li r y,r 17 Cj ~thiP~f`i`( iLt .~ I td; : 1 PERMIT NUMBER DISCH • r.. r+ (~ 11r i': <br />ZZ NUMBER ~- ~- F r t-'1 s_. ~ t -,,:. <br />.... <br />. , ," <br />FACILITY _" ` " ' MONITORING PERIOD (-~ ' ~~ -" ' '~ ` ~ -';"=F"F' C t~tl`+'r't'i(~I <br />t f t ! "q <br />LOCATION t~IL. ;.,- t I ~ r ~ I ` YEAR MO DAY YEAR MO DAY <br />n t:itx , <br />t ~ FROM ~ °a sr ,.._ .t. TO - ~ ~ .i..., . ~ , ~ ~:: 3 f ti• :~? -14 <br />._~ ~ .; ~~ <br />;~•i" i }`~ : f . •: ,. ' '}.:_` F - l :__ ' ; ~ ~ 'dt ' ~,`_l.. t-.r • NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br />OF <br />AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE <br />j ).. .:.}}.! t ?' >' ~.~. SAMPLE ,-~:.. ~~~ { ss~•4 3 ~: t*-;`: ~: •~•t. ts•-s::~:.;~ J;.~. .~.., x~. <br />"- ~ t'-&^ <br />~.` I SUAL.. MEASUREMENT <br />'=;`~'J~~''`=' ~ PERMIT ~:.#.••~•#'~# F~~~G~',~ ~'•;=`--I ####Fi£"~t• ##~€'}~~#'•J4' ##if-##3#' ~:-',i, k• ~ ~a~°~.~t~..Y i~:'.~~', <br />~'~'F•'L.t~~ftE7• ir!~.C-?~,`:, t1~L~~ REQUIREMENT I~`dT i'~A~i "a -*~. r;.~,# <br />SAMPLE ~} <br />MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />SAMPLE <br />MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />SAMPLE <br />1 MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />~, SAMPLE <br />' MEASUREMENT j <br />PERMIT II <br />REQUIREMENT <br />SAMPLE <br />MEASUREMENT <br />PERMIT <br />REQUIREAl1ENT <br />SAMPLE <br />MEASUREMENT <br />PERMIT II <br />REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIV OFFICER t certify under penalty of law that this document and all attachments were TELEPHONE <br />t ~ prepared under my direction or supervision in accordance with a system designed ~ Q~ DATE <br />111IV° ~~ ~ ~e(r to assure [hat qualified personnel properly gather and evaluate the information `_(/~/ <br />/~ submitted. Based on my inquiry of the person or persons who manage the system, <br />~~ _J~, ~ or [hose persons directly responsible for gathering the information, the information ~ p, ~~ ' ~ ~ ~ /'1~ ~~ <br />(/ ' submitted is, to the best of my knowledge and belief, tme, accurate, and complete. ~~ /~1 (j///ry~~C <br />[ am aware that there are significant penalties for submitting false information, SIGNATURE OF PRINCIPAL EXECUTIVE <br />TYPED OR PRINTED including the possibility of fine and imprisonment for knowing violations. OFFICER OR AUTHORIZED AGENT AREA NUMBER <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) CODE YEAR MO DAY <br />r <br />,. <br />,. <br />~`}t ~ f` ~i*1 ..: i ~ tiJ :'. (~ tl'••v J"R i' 3 i.._ x ~re 6 e U ,~~ _ _ <br />J t- c _ <br />i i L !~i <br />' .c ° t '7 ~ r <br />.l. ! t t` <br />( r~ 1 <br />~ ,} ' <br />~... 4rT ~ L:.-. j 1St rt4 ~~ L?~~i 1 ~....~. 3-_ ,.._.l L~'_)L (. lE ~. __ i l.'i ~CJ i, i'~f< ~ "~-..... rF. .. ._ ' __. .. ' ~._ 3 ,... ,) s .. t f.' ,r"'. 1=.'~..• .~. r~ <br />i EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. PAGE ,,,1 OF <br />~;:t~t~)"~Ci:'••-;='~}ris;is a~~~f}prm. <br />._ ~~ <br />