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PERMITTEE NAME/ADDRESS tlm•luJe Fixil(ry.Yanr.7.rtrminn iJpi$emnrl <br />NAME <br />ADDRESS <br />'~ :~ <br />FACIUTY _ y :. <br />LOCATION . ;; EL~>' C `: L 6 i~ <br />-.. h7 . i H ? 1 ! uFN n tit i !•.iK NiGh1A:`:F=R <br />NATIONAL POLLUTANT DISCMAgGE 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. 2040-0004 <br />f~BLAN <br />Y <br />NOTE: Reed Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION Plp. FREQUENCY <br />OF SAMPLE <br /> ~ TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE ' <br />I :~1~ r<: MEASUREMENT <br />"','- . PERMIT :: ~ ~ ,..,_~ :.. '.. ,-..• _ _ c. <br />'.F = i. .' ! " = REQUIREMENT I~' ~~ ~ ~ ~ <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 /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I ctnify under penalh of law that this d~n:urnent and all attachrnrnts wcrc TELEPHONE DATE <br /> prpared under my dutcuon ar :.vpen~i.ion in accordance with a system dtsigttrd <br />r <br />~ ~ to ossure that qualified perxonnel property gather atxi et•aluate the mfonnanon <br />! c <br />~ ~ suhmnted. Based on my inquiry of the ptrwn oc perzorts who rttanogc the system. , _ <br /> rrwns directly restwnsihlr fnr gathcrirg the infotmtainn, the infxmatinn <br />nr those <br />_ <br />~ <br />~" <br />" p <br />submin ~ is, to the hest of my knowledge and helieE trot, accurate. and complete SIGNATURE OF PRINCIPAL EXECUTIVE <br />' <br />- <br />' I am aware tfuu these are xiEmihcant p~~nnhies foe sitbmunng false infonnnm~n. <br />OFFICER OR AUTHORIZED AGENT _ <br />NUMBER <br />COD <br />YEAR <br />MO <br />DAY <br />OR PRINTED <br />TYPED itx•luding tha possibility of tint and impriwnmcnt for krx~wing ciolauoas E <br />GUMMt1VIJ AMU UYLNIYMttvt~ yr ht~r rtvvlttvtw incrcront.c m~ auaa.nrncnw nc~c~ <br />:R PFcEC IP. EVEn!T <br />3AIIPLING iNSTF:U <br />EPA Form 3320.7 (Rev. 3/99) Previous editions may be used. <br />~~ z . A. 1 . r P(~. ~. F oR ~' EC~I) T I'%ENf F_=MTE <br />7~tii3 ~3:r~ -{Tart fornl. PAGE OF <br />