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PERMITTEE NAMEIADDRESS ~n,~lnde Fariln•,v,~„~;r.~•w,,,„,~ngr,tirn <br />NAME ~ ; ...'=°_~;:;•'I .If~1, <br />ADDRESS • ~ 1 ~~~ 1- <br />FACILITY <br />LOCATION, . , <br />ca f~1B4 <br />hIANAGEE? <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) Form AppfOVed. <br />DISCHARGE MONITORING REPORT (DMR) jp? OMB ~• ~~~ <br />~, <br />PERMIT NUMBER DISCHARGE NUMBER '. FVAL R3LAhty: <br />MONITORING PERIOD , r I ~Q~;D TC3 SCULL ~ OM GLLH ~~ <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />' SAMPLE f <br />~' <br />F.. ," ' <br />MEASUREMENT ~.- ~ • v ~' Z ~ jG~t; ~ Y[r l} <br /> PERMIT :t•-> ~ -: >+ -i -, ., r; . + ... i - ! <br />L.. V;:' REQUIREMENT ~ ~~~~ -' <br /> SAMPLE / <br />~ <br />it`:' - MEASUREMENT < '.. «. z «, C,<. - ~' f~• ;:;. ,', <br />• PERMIT ~-- ~ : -k c ~ . ~ , <br />tF F•~ LUi_I~; 1 REQUIREMENT • ~ i^ ` <br />._ - SAMPLE ,< <br />^L+ ~ . . MEASUREMENT ~ / ~ ! _ - % r. (7.., <br />• PERMIT x-. , - _, ~.ir•.. : r ~ . <br />r_r t•~L. Uc~J ;' G;.::.. REQUIREMENT <br />•~ I `~ it ~ ; . SAMPLE _ <br /> <br />I-OTAL REr~Q~').i <br />MEASUREMENT <br />~' <br />- lJ - , ~. <br />` i ~! ~• _ PERMIT + • ~; <br />FFLUr_1~: -' - REQUIREMENT ' <br />r • ~ ~~ <br /> <br />- SAMPLE <br />G- ~ _ <br />J <br /> <br />`E <br />C_ ! . <br />1 <br />G' ` '~ _ _ ~ : MEASUREMENT . ~ <br />i PERMIT a a :... - , -_ i - ., <br />.F . :. REQUIREMENT -- '~ Mk <br /> SAMPLE ~ "~ <br />I G ' ,- _ MEASUREMENT u . r.r ~U : < ~,. C- 'i, ,t i~ <br />- - PERMIT - ~ _ _ ~ ~ ._, <br />.. F I-i tJf'F~'~( - - REQUIREMENT ~~,' ',:~ <br /> <br />SAMPLE . - _ t/ <br />_ ".._ F2C.CC'• _ ~ MEASUREMENT <br />'-~ <br />C~ , G U <br /> PERMIT <br />!' REQUIREMENT ~ -' ~ `~ ~ . <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I rerttfy under penalty of law that tM5 document and all atwchment; weer TELEPHONE DATE <br /> prepared under m~~ dire~uon or strperviston m accordance with a .rystem designed <br /> a, assure that ymhtied personnel protxrly gather and evslume the information <br /> submincnt. Raced on tm inyuin- of the person or perx~ta w•ho manage the syttem, <br /> or those persons dira:tJy responsible for gathering the mfcxmation- the mfortnatkm <br /> submntcd ic, to thz I+cKt of my knawlcdgc and belie(, true. accurate, and complete SIGNATURE OP PRINCIPAL EXECUTIVE <br /> I am aware that there arc sigtuficant puwlties for submimng false imiimt~non' <br />f <br />L <br />l <br />i OFFICER OR AUTHORIZED AGENT ARFA <br />NUMBER <br />YEAR <br />MO <br />DAY <br />TYPED OR PRINTED ur <br />nowm4 s <br />o <br />,mon, <br />itxluding the Ixnsihili[y of fine and unprisonmcnt CODE <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Re/erence alt attachments here) <br />EPA Form 3320-i (Rev. 3/99) Previous editions may be used. ~ _~ 'T~Iis is a 4-pact form. <br />