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PERMITTEE NAME/ADDRESS Undudt FacilitJ A'anvdLacution rJlhJfaenn NATIONAL POLLUTANT DISCHARGE ELJMINATION SYSTEM ((NPDES) <br />NAME _, DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS ' ` i '~ •~ ~ ~ I <br />L t7x ~ PERMIT NUMBER DISCHARGE NUMBER <br />! ~ <br />MONITORING PERIOD <br />FACILITY Htiri j ~ _<i~. <br />YEAR MO DAY YEAR MO DAY <br />LOCATION ~q FROM TO <br />Form Approved. <br />OMB No 2040.0004 <br />TRYis TI <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY <br />of SAMPLE <br /> <br />EX <br />ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> <br />- ,,, , <br />- -- <br /> PERMIT .c a• z r ~~ `''~' " : ~ . , <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />_ <br /> PERMIT , , ,~~ t~ <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT ~ ;; ... . r. - , <br /> REQUIREMENT ' <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT - _ ,- - <br />-- - <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> ' <br /> ~ .... ,. , . ~ ^- Lit; ;;/; i ~_ <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br />_ ~ , <br /> PERMIT - _ - , ~"~ ~ , .- <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> <br />PERMIT <br />REQUIREMENT ' <br />TELEPHONE <br />NAME/'fITLE PRINCIPAL EXECUTIVE OFFICER { rrrli{> °ndcr prrolt..,r i~w mJl mi+dawnrnt and :dl wuarhmrnt+wrrr <br />+i <br />ned <br />ith <br />~ <br />te <br />d <br />~ <br />d DATE <br />_ <br />„_ - _ <br />atxr w <br />u y <br />. <br />m <br />r <br />F <br />.or <br />prrpurcd under my direction ur+u{xni+{on in x <br />to uaurr thus quulir~rd prrwnurl properly {lathtr and e+aluutr tIK informatiua <br />_... - . _ cubmittd. Baud on my inquiry ad the prrwm or prrvm+ who munn$e the y+trnL -__ _ <br />,• _~- or Ihocr prr.on directly reapon+ibk for gnthrrin{; the information. lhr inrormnlHm _ ~ ~ ~ <br />~- - <br />/~ ,; c._ _.,~ <br />~ 1 ~~ .ubmiurd i>. to Ihr lK t of nq knowladgr and belie(. True, raruratr. and a.mpkla SIGNATURE OF PRINCIPAL EXECUTIVE <br />( 1 <br />\ '. <br />~.~ . <br />i <br />t <br />~ ~ <br />.:Jt <br />~ I um aware that there an.iQnlficaw prnuhir. for+uhmiuinit lulu information, pFFICER OR AUTHORIZED AGENT AREA NUMBER YEAR MO DAY <br />TYPED OR PRINTED itw9udin>: the p.wsihilih of fine and impri.onmrnl for knnwin{t vinludans. <br />COMMENTS ANU t1CYLAIVNIIVIV yr alvr vtvt_'+nvt•.~ {r.~.~•a•.•~~ v.. ~••~~•••••-•••- ••-•-. <br />-•L.IEL` rt?R IUYR1c4HR PRECI - ~- - - Gr <br />~ --- PAGE OF <br />I T1iic i, a -~-ratt t-cxm. <br />EPA Form 3326 ' F' - <br />