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PERMITTEE NAME/ADDRESS 1lnrlude Farilite:Yamr//oration iJDiJJrrrnp NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS <br />- ~ PERMIT NUMBER DISCHARGE NUMBER <br />FAauTY _ •- MONITORING PERIOD <br />LOCATION YEAR MO DAY YEAR 0 DAY <br />FROM TO <br />J, .:_ ~ <br />~ 1 fVfJR <br />t 5~~~ I"IN 5 <br />F - ~ i ~tAL <br />SR~~•: -13;•t>= I'+RfJC, TIC I H <br />Form Approved. <br />OMB No 204p-OpQ4 <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY SAMPLE <br /> OF <br />TYPE <br /> EX ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE ~~ <br /> MEASUREMENT <br /> PERMIT , -~ ,: '~ •:> <br /> REQUIREMENT t'1 I M i fvl(J''i hil~') <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT . <br /> REQUIREMENT ~"- •~ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ ,_,: , . _. ~, . . ~.: <br /> REQUIREMENT .~;;i;,:: ,,.;,; ~,.-. - <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - .. .. <br /> REQUIREMENT - ~ `' r <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT :r - - .... :,.-. .. ~.. ~. ~ _ <br /> REQUIREMENT _ ._ ', ~~,._; _`:., J ; `," ;.~ •: hl0(•: <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ , ... - .. - - .. _ <br /> REQUIREMENT - - <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - --~ n r_ - .. - _ . - __ - , <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certlh under penalty of Iaw that Ihi, dtRntnCnl and all uttaehmenL weer <br />d <br />. di <br />i <br />d <br />U <br />i <br />d <br />i <br />' TELEPHONE DATE <br /> prepare <br />un <br />er m <br />rt. <br />un or caper, <br />on in accor <br />aner w <br />s <br />sh a .y,lrm des <br />yoed _-_ ~: <br /> to a.,wrr thus yualiRed prrx~nnel pr~perl~ Rasher and evolualc the information _ <br />~_"'-~ _ _ wbmiucd. Ba+ed on m} inyuin of the lw•r,un or perw~m who manage the„tem. <br /> or thuw• prison, dirrcth re,pon,{hlr fur gathering the information. the information ~ ~ _ - ~ , ~{ <br />( ~- , ~ ~' ~ whmitted h, to the twM n! mr knowledge and belief, true. accurate, and cumptMe. ~ - . r ~ Ji ~ •_ ~ <br />~ fC~- <br />~ `- - - 1 um aware that there are signiticent prnalUr, fur,ubmiuing ful.~• information SIGNATURE OF PRINCIPAL EXECUTIVE ~ <br />TYPED OR PRINTED ~ , <br />including We pr»viM1iW of fine and impriw.nment fur knowing violntlom. OFFICER OR AUTHORIZED AGENT AROEDE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Relerence all attachments here) <br />;c <br />=orm 3320-1 (Rev. y'99) Previous ed+tions may be usE <br />This is a 4-P;ctt ti~mi. PAGE of <br />