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PERMITTEE NAMEIADDRESS ~/nrlutit bmiiu, \w+.. 1+,~,u;.,r; ;I I+;r,nr+r NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTE61 ((NPDE$J <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS <br />PERMIT NUMBER DISCHARGE NUMBER <br />FACILITY MONITORING PERIOD <br />LOCATION YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved <br />OMB No 2rJ~i0•UUUa <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 <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE - <br /> <br />1- <br />--/~ - <br />~_r <br /> MEASUREMENT `~ ~ ~ ~ -- <br />` - <br /> <br /> REQUIREMENT ~'•, ' <br /> SAMPLE <br />~ <br />~~ <br />/~ <br />I ` <br />/ ~ ! <br /> MEASUREMENT ' " <br />- <br /> <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 /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I nrlit> underprnull~ ~~I r•,tt Ibal lhi.d.KUmen1 and all :dWrhrtta•nt ware <br />wm ur <br />.u <br />kn i.iun in a <br />urd <br />~Ilh a ~, U <br />r <br />d und <br />r n <br />di <br />c <br />m d <br />si <br />md ~ TELEPHONE <br />: DATE <br /> <br /> <br />,_ . <br />yrrpa <br />r <br />e <br />r. <br />r., <br />{ <br />cc <br />m <br />r <br />e <br />e <br />g <br />In n~arrr Ihul yrtnhfird ~,n+amel pngH•rl, Kal hrr and rl:duWr Ihr inM1+rmulion ~ _:~ <br />4 _ - <br />- ____- <br />- .uhrnntrd. Raav1 nn m~ ^upun ul 16r {n~r.un ter {u•nnu. rhu munaKe Ihr s~strnl. ~-- <br />~ ~ <br /> ~~1' Ilnnt' Pt'n.rll, dlrectlt rt~.{Y.n~r~dr rllr Kul ht'r111K Ihr Inrnrnl.lll~m. lhl' mtlN'mannll <br />.w lyd <br />~ <br />rn <br />~ <br />bmu4 <br />l w I <br />th <br />f m <br />An <br />e <br />nJ I <br />•Ie <br />L Iru <br />. utr <br />l <br />l <br />lN <br />b y 1-- <br />-'~` <br />~ - ~_--~- - ~ - ( - <br />` ~' t ~' ~ - <br />~ ~ <br />~ ~ <br />• _ . a <br />c, . <br />r <br />n <br />~ <br />~ <br />K <br />a <br />h <br />r <br />a <br />.r <br />r <br />tump <br />a <br />u <br />e <br />est - <br />. <br />SIGNATURE OF PRINCIPAL E%ECUTIVE ' - <br /> I um ,mart Ihnl Ihen• un~.iKUlfic:un {xmalur• hn mhmlttmg ta{~e mformaut~o. <br />TYPED OR PRINTED ineludinK ttm p~n.iM1iN ~~( fma .Ind imprnonnum fnr ItdtNlnL' , bduGon,. OFFICER OR AUTHORIZED AGENT AREA NUMBER YEAR MO <br />CODE DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference a!I attachments here) <br />tP.4 Form 3320-t (Rev 3'991 Previous editror <br />Thi, is 3 =l-dart f~nn. PAGE OF <br />