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PERMITTEE NAME;ADDRESS Unchrdc Facilirv.4`a+ne'Lxorlon ifDif~rrenn <br />NAME <br />ADDRESS - - ~ ~ ~= <br />. _, ~sEl <br />FACILITY ~ }~, <br />-o ~i~~~ <br />M APtAf'~C17 <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 />rC,nn r.l,proved. <br />OMB PJO 2040-0004 <br />( SUi3f~t L7W T <br />F - FINAL RBLAN~I <br />SS-2 SLOT STI~RAOE l'0 RFt~ WASH ~, , <br />I <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. <br /> <br />~ FREDUENCY <br />OF <br />ALYSIS SAMPLE <br /> <br />TYPE <br /> AN <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />-([ ~ MEASUREMENT <br /> _, . f, <br />• <br />}_~' _ -. PERMIT <br />REQUIREMENT < ~ <br /> <br />'s';:l i.. SAMPLE <br />"OTAL Ri <br />' MEASUREMENT <br />_ . <br />,.. - .. <br />;..'t '' ~ <br />:_ _ _ " PERMIT <br />REQUIREMENT - ~ :. , .: t_ r <br />' ~ r ~ ... ,.. ~ • , <br />+. ~ ; <br /> <br /> SAMPLE <br />;~: ~ : ! MEASUREMENT <br />.. <br />• PERMIT <br />r'F._~ ~: .1 ~ REQUIREMENT . <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTNE OFFICER I <cnify under prn:+In• of law that Uus d+xument and oIl attw:hmrnts Were <br />ared under my dim:uon or s~tperv-ision in accordance with a syslart tkstgned <br />re TELEPHONE DATE <br />~ <br />,~ i ~ ~ /~ C_ ;.ti ; ,, f ~ ~ p <br />p <br />to as_+ure chat qualified perwnttcl properly other and et"aluate the information <br />submit0.Y1. F3ased on my inquiry of the p;-rson or pcrscros who manage the system. <br />infotmatuwt <br />the mforrnauon <br />in <br />th <br />ibl <br />f <br />th <br />d <br />l _ __ _~_ <br />_ - _ - <br />- ~ ~ ~~ <br /> ur ga <br />g <br />e <br />, <br />y respons <br />e <br />er <br />or those persons <br />trcct / <br /> submitted is, to the Fist of my knowledge and belicl: true, accurate. ansl completes SIGNATURE OF PRINCIPAL EXECUTIVE <br />~~ t t " ~ <br /> <br />TYPED" OR PRINTED I am aware that there erc signiticant penalties for suhmnnng false informotion. <br /> <br />mcltcding rhr p.rsaibility of floc and nnpnsonmcnt for knnwmg ciointions. <br />OFFICER OR AUTHORIZED AGENT <br />AREA NUMBER <br />CODE <br />YEAR <br />MO <br />DAY <br />I COMMtN I5 ANU tAYIJo1fVAC wrv yr Mrs <br />- 1 j;t. t. _i i lt,lrf i+ii;i PAGE rj~. <br />~A Form 3320-1 (Rev. 3199) Previous editions may be used. <br />