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PERMITTEE NAMElADDRESS Ilnclxdr F'ocifih• ynme//~ca6xn if UiJJnrnf~ NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (D R) <br />NAME ,_tE. <br />ADDRESS ,i(I ZUN ~' <br />-; ~ X J~~ PERMIT NUMBER DISCHARGE NUMBER <br />` ~+` ~ MONITORING PERIOD <br />FACILITY r ~ -:URI ZtJF~ YEAR MO DAY YEAR MO DAY <br />LOCATION ~ ~ FROM TO <br />Form Approved. <br />OMB No. 2040.0004 <br />r t t+tnt_ <br />Rgi.M I NE DRNG T~ TUTTL.E <br />NOTE: Read Instructions before completing this form. <br /> <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION IJQ• FREQUENCY <br />of SAMPLE <br /> EX SIS TYPE <br /> ANALY <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />_ ~-. SAMPLE <br />„- MEASUREMENT <br />- <br />_... • <br />' = ii,y _ • <br /> PERMIT ..,: ~ .. .. ,€_+ <br />l;Ji:T REf <br />v`:T <br /> REQUIREMENT :30UA A~.%~ ;~fill_.~r '•'•'•' <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> <br />PERMIT <br />- - • " _ =~~••r.•ff•z-;: ~<>=PORT Rl-tPC3F;'; <br />,_ ` <br /> REQUIREMENT 3~.:DF, tiVL-' 't~ATi:.`~" ~ ~ 1vI'~ i :' <br /> SAMPLE <br />,, <br />i1 , MEASUREMENT <br />; <br />_ <br />,, • -. PERMIT ~•~^..,.. t 1-:... Rf-:F'i~t='.T <br />_ REQUIREMENT ~-DFt a'vi~ JF~ ~.t" ;•'. <br /> SAMPLE <br />;~ MEASUREMENT <br />- - PERMIT .. ....... ~'i n ~_+- _ - ! ~ ~ -_ <br />:: ;,- : REQUIREMENT -, J, ; :;~~ s ... <br /> <br />SAMPLE <br />MEASUREMENT <br /> <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 crrtir> undrr prnnlq +.f low tnm thi+d«umrnt and III nttxchmenf+wrre <br />arrd umler m. direction nr wp~n i+iun in nca+rdnnce with x +~+tem dr+il;m~1 <br />rc TELEPHONE DATE <br />_ _ <br />~ p <br />p <br />to ntiwtre thrt yuxlifxd prrwmnd pruperl~~ Kxther and rcalunle Uce infurmntiun <br />' <br />~~ <br />- +uhmiued. Rn+ed on my inquiry of the prrsun or pers+ms who mxnxQe the n}+trm. ~ , <br /> ..r Ihrnc prnoaa direrllr respnnsihle fur ¢xthrrinR tM informxti+w, thr infurmnti+m <br />~ ( <br />i wl <br />d h <br />li <br />f <br />Inx <br />u <br />xt <br />nd rum <br />kte <br />d <br />k <br />d - " ~ ~~ <br />• ~ ~ <br />`•1 <br />' ~ p <br />. <br />Ar xn <br />, <br />r, <br />ccur <br />e. a <br />.ubmitly <br />is. tx thr hest of m} <br />no <br />e <br />r <br />r SIGNATURE OF PRINCIPAL EXECUTIVE ~ <br />' I xm xe arr that there ore si~nifcenm prnxltic+ fur +uhmittin~+ fxlsr infnrmxtixn. AREA <br /> +inWtians <br />+onment fur Am+win <br />ibilih <br />f fin <br />x <br />d I <br />i <br />l <br />di <br />lh OFFICER OR AUTHORIZED AGENT NUMBER YEAR MO DAY <br />TYPED OR PRINTED g <br />. <br />e <br />r <br />mprt <br />nr <br />u <br />nk <br />r pmc <br />o E <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />~ EPA Form 3320-1 (Rev. 3/991 Previous editiofis may be used. <br />