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PERMITTEE NAME/ADDRESS (Include Facility Name/LocationifD~erent) <br />NAME „,--. r <br />ADDRESS L.C~r.~ ~iir ~ ~~1 ~f•`1~Y~)°.l E"1 :1. i a.•:_ <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />".G.' 1 F'~ ~ T +t-aL~ ~) /'~(~` ' t : '.~i i i" ~.-x•'r_'- fir- ' ~ MONITORING PERIOD <br />FACILITY - _ <br />Ir..~ i _ r i...l s`t ~` ::~L'i`.i i ~e 7. y!~n . <br />_... ... <br />LOCATION YEAR MO DAY YEAR MO DAY <br />~/~a e t t (,~ 1 I > ; t ~-r' .r. RO ~t,_ _ O ... <br />F M ~.: T ~.:-~ . . ~ <br />Form Approved. <br />OMB No. 2040-0004 <br />f'7 ;~ fVC7R <br />~e:~ <br />-~: f'~ ~. ;'tt~ ..; .~. ,_~~i'1?`-i l'i 4.'w.: I .t..X'..C.. f ;t..?;. <br />tJnTC`. Qn~.i InMr..M:..nc. heii.r wi. ..1..f:.... ~h:•. s....~ <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> <br />EX OF <br />TY <br /> ANALYSIS PE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />1_f ~ I._ C-': ~ .,! .s 1:; ` 't ~'; ' '~ ~;1 ~. <br />r ~~'` ` <br />SAMPLE SI' .~ ',f :~' 7t i.` <br />' i t~ .°.l. Z .y~:. _~' .k!.. yt. _? :~i' ~r'SC~c' 3; 3t' .'•~' •i~i ;#' 3t 'ik'J' <br />tv` I ~L;AL.. MEASUREMENT <br />L~~t,rF;xc `: '::~ PERMIT ###3E## RI"'t~F~~" ~~i^". ###### ##:~'~'## ; <br />~~'F'L.l.)~~~ i' is?iJ~S Vr7~-_l.~r. REQUIREMENT I~.1~7 i'~A}C $ t~:_ C1 .:..;,~.-:r <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT Q <br /> REQUIREMENT '~/ <br /> SAMPLE <br /> 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 /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL IXECUTIV O FICER I certify under penalty of law that this document and all attachments were T ELEPHON E DA TE <br /> prepared under my direction or supervision in accordance with a system designed /J~ <br />/ <br />~ <br />ov ~ to assure that qualified personnel properly gather and evaluate the information ~ <br />~ <br />/ <br />jr <br />~ <br /> <br />submitted. Based on my inquiry of [he person or persons who manage the system, 1t ~ <br />Y <br />Y ,[.(,/L~ <br />A <br />' <br />- <br />^ <br />~ <br />~ or those persons directly responsible for gathering the information, the information S ~f <br />~ ~ <br />~ ~ <br />e <br />submitted is, to the best of my knowledge and belief, true, accurate, and complete. <br />I <br />h <br />h <br />if <br />SIGNATURE OF PRINCIPAL EXECUTIVE ~~ ~ ~ <br />~J <br />Jr ~ <br />/V1 ~ / <br /> am aware t <br />at t <br />ere are sign <br />icant penalties for submitting false information, , <br />TYPED OR PRINTED including the possibility of fine and imprisonment for knowing violations. OFFICER OR AUTHORIZED AGENT AREA NUMBER YEAR MO DAY <br />Pf1^I\ACAITC Awln CYDI e1JeTIntJ nC AHIV \/Inl ATIn\IQ /O..L.. ~....~~ ..11 ..u~_I"~__. CODE <br />~'~,=ia r~,_, : t :'?•i_~.-^sE~f~,.'~t~ ,_~?!~~ i ~'~= Gu`.,'..~_ :3r_~: }'t.<-;~Z~v'fi _ _. i~ ~' )"~.,~t~tal'.,.~~ ~t:f! IL~#`_'i [... i`?T_' ~".,~~l=tE_...I.l:<%~• t'~.ii~ ~..-~=:L <br /> ~14'I`?r ~ 9.1"9 ,`; F;~.~~.It~. <br />,. _. <br />•- - _ ,._ <br />T~~.', r'~! "r i 'P'1 `~ ( ;/i t (":..tx :,;:.v > -f- J ':lt' r ;'--"»:- <br />~.: ~} ~ ~1 ~ 1 ""• ». ' ~ ~ . .._. . ...> ~ _.. 1" ; i" .: I I ~: v ... ~ a _ r- i a L~ ... ' ~ . _ Y ~- <br />..... _. <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. ti _ PAGE OF <br />~.- ~)~ rF.tr Q~'~its;is~4~~i~fprm. r' <br />