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PERMITTEE NAME/ADDRESS rlnrlude faiGrv Yamdlurclian ijDijfrrcNl <br />NAME .. -. <br />ADDRESS ~QR <br />i'ta <br />_ ri <br />FACILITY ~~~ <br />LOCATION ;_ H <br />LAN <br />rC1 ir14~4 <br />RNA~ER <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved. <br />OMB No. 204D-0004 <br />!dE I;RNG TR I!3 <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ, FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE - <br /> MEASUREMENT <br /> PERMIT .. ~•#Ry •. x :rr-:- ;LL.,. <br />- 4I ~ - v ..1 <br />' .REQUIREMENT '~+;7 T~ ,- , <br />., '= <br /> SAMPLE -- <br /> MEASUREMENT <br /> PERMIT f` ^ ' .- -; t': . <br />. REQUIREMENT '~~ ; ~: _ <br /> SAMPLE <br /> MEASUREMENT <br /> <br />' <br />PERMIT r-. <br />- ~ I <br />- - ~ -- .r. s. +r <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 EXECUTIVE OFFICER I crrtih trmlrr penalty of law mat mi, d xumrnt and ull attachmrnts were <br />d TELEPHONE DATE <br /> prepurrd under my direction or atprrvi,ion in xcordann• with a s)~tem deniQnr <br />_ __ _ to u urr thnt yualifird pnsonnel properly gather and r,oluatr tlrr information <br />_ <br />- <br />~ <br />-' submiitnl. Kurd un m, inyuin of thr prison ar prnonc who matta)Ze the s'sirm. <br />or three prrxmc directly rrcprm,lMe for t;utherioA thr inforttwtirm. thr information ~`~~~ , <br />•' <br />~ <br />~. <br />,-, <br />. <br />~ ~ ,uhmiltrd h, irr the he,t of m~ [nnwiedge and belirf. trvr, arcurale. and complett. <br />SIGNATURE OF PRINCIPAL EXECUTIVE • ~T ~ ~~~ _ r' '~ <br /> 1 am awarr that them are ,ignirn•:+nt pcnaltfc, fur wbmittinK false Informntioa, <br />t fist knowing ,Inlution. <br />l <br />di <br />th <br />a <br />ihitH <br />f fi <br />e a <br />d i <br />is <br />r <br />i <br />OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br />TYPED OR PRINTED . <br />nr <br />u <br />nK <br />e l <br />i„ <br />y o <br />n <br />mpr <br />rmm <br />n <br />n O E <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Aelerence all attachments nereJ <br />••, c <br />EPA Form 3320-t (Rev. 3/99) Previous editions may be used. <br />3C~~ <br />