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PERMITTEE NAME/ADDRESS rlnaluJeFurilin•:vumt:lwxnriwniJDyj•rcrtrl <br />NAME - <br />ADDRESS'' ' <br />FAC1urY : ;; ; , ; <br />LOCATION •;;:Ei •tr 1.~ is ~ ~ ~~'I <br />- n,:-.~tnr~o <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 />7 I NOR <br />(5UAK 1;IW > <br />Form Approved. <br />OMB No. 2040.0004 <br />SG~i3t5 SEDI PLttvD TO RED WASH <br />• ~" i <br />NnTE~ Read Instructions before Completing this form. <br />PARAMETER QUANTITY OR LOADING DUALITY OR CONCENTRATION Np• FREDUENCY <br />OF SAMPLE <br /> ~ LYSIS TYPE <br /> ANA <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> , . <br /> PERMIT tr . ,, - .. _,~ ;:.. I„I1 .~ :-H <br />:: •i ~ ~ _ REQUIREMENT • <br /> <br />". <br />SAMPLE . r <br />'t <br />J;~F i . ; "' MEASUREMENT <br />. <br />• <br />_ <br />-i~'S~' PERMIT • <br />" <br /> <br />' - <br />' - rl-i <br />f~~l;P3 <br />'F <br />r=~-~~i; -: REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> . .. , <br /> PERMIT . ~ - <br />_ T ' ! REQUIREMENT <br /> <br />i•' i' SAMPLE <br /> MEASUREMENT <br />_ <br />% PERMIT .~; .:.~. - <br />° i'1~•JTI i ly . <br />} REQUIREMENT <br /> SAMPLE t <br /> MEASUREMENT <br /> „. _ <br /> PERMIT (. ,. t" , <br />_?"" " REQUIREMENT i_ <br /> SAMPLE <br />' f-' <br />;' l' T ~ MEASUREMENT <br />. <br />' <br />PERMIT t .. <br />t,it i' '~ ; ,~ , <br />( : ' _ REQUIREMENT <br /> <br /> SAMPLE <br />. ; i '"; MEASUREMENT <br /> <br />• • <br />PERMIT • ., -~- .. <br />' REQUIREMENT • <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER 1 cen~fy under permlty of Iaw' that dtis document and all atauhmrnts w•crc TELEPHONE DATE <br /> ared under my dinltion or supervision in acttrdancc with a system designed <br />re <br />t'" ,[. ~ p <br />p <br />to ncslnc that qunlifieti personnel properly gather and evaluate the informanon -- --- ~ ^ ~ _~~: ~ - <br />_ <br /> stibntlned. 9atied On my Itl(Inlrv Of IhC petsort Of persons w'IH) ftlallflKC ihC SVStem• <br />the infomwhon <br />the infortnfltivn <br />onsible for Gatherin <br />tl <br />res <br />di <br />h - " S ~Y ~ <br />~) . ,: f , <br />y <br />p <br />g <br />or t <br />ose persotu <br />rec <br />submitud u, to the beat of mp knowledge and bchef. tnx, accurate. and complete. $IGNATURE OF PRINCIPAL EXECUTIVE ~ _ ,f ~ <br />- ~ - <br />, < ~- <. '+'` '' S` <br /> I am awnrc that there are significant prnnlNes for submitting (aLsc information. OFFICER OR AUTHORIZED AGENT AREA <br /> <br />i <br />i <br />lation <br />f <br />m f <br />k <br />ibili <br />i <br />d <br />i NUMBER <br />CODE YEiAR MO DAY <br />TYPED OR PRINTED or <br />now <br />ng v <br />o <br />s <br />ty o <br />l <br />ne an <br />mtpr <br />sonme <br />including the poss <br />COMMENI~ ANU txYLANAIIVn yr rrni <br />EPA Form 3320-t (Rev. 3199) Previous editions may be rued. <br />(ncl vrvna.c an auas a.nn,v,+w .,c. c~ <br />.~R PNECIP. EVFt~I"I. ~ SEE I <br />SAMF 1. I Nis I I+f5T!<; UC T I pNS - <br /> <br />PAGE OF <br />