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PERMITTEE NAME/ADDRESS (Jnclude Facility Name/Location if Different) <br />NAME ~i:+~;a'I ~~+'.t`'lI ~''I..r~i_..~ _. ~.~,.~~...~i~l~t'~I~, ~%."C: <br />ADDRESS h`t~..°,~ ~"I~~st .y Z #~~: E~ ~ t~~~ <br />FACILITY I'•i~1'~ e~ar"~1', ~ ~~33 k Ili+t~ <br />LOCATION ~'~,iia~C.~Fw..'-'t '~<`~, F~~~~2r <br />t~~"f ~'~i: ~. ~f~.l'41~, :~ ~~l~~a ~~tliN~.. r~l~4i~fitOiC~~~ <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES) <br />DISCHARGE MONITORING REPORT (D R) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY., Y R, MO D <br />FROM ..r w•-.• kr;. 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" <br />. <br />- ,.., <br />~rt~~.?.3~.~9~i t '`;;~~~ 41a~1i..~3 REQUIREMENT: r'~:•is'~ ! ._; _. <br />_ <br />- i"fts.r`'[,.. _,,~, <br />~..`r_.t A!i A.J ~ '..it`~~.F ?. .31''i <br />SAMPLE L i.+u~ d •xls.: eYr"/.-•s •i+••S: ~r•x ;s ~ <br />`r .r <br />°~'~i~?~ ~d~ ~ i ~'~t~{`~`i ~~,:.tOsb~ MEASUREMENT <br />t <br />~ <br /> <br />~if'3~~`~,'~ .s ~, PERMIT ~ <br />' _, s , ,., -+~: ;. .... t-. ~ - -- sz <br />, ~ 1 - <br />~ "1„,, r ~~ ~-1'~" ~ `~0~~;.J~ <br />.~'Y^ ~., C•I ~~I" A::iv t.~,..r~ REQUIREMENT .~I..ta`.. ~,E~` ,~; fy ~ ;_~ i ~'ir <br />NAMEITITLE PRINCIPAL EXECUTIVE OFFICER f certify under penalty otlaw [hat this document and all attachments were <br />i <br />d ~ TELEPHON E DATE <br />_ gne <br />prepared under my direction or supervision in accordance with a system des <br /> [o assure that qualified personnel properly gather and evaluate the information ~ , <br /> <br />..,.- <br />(A <br />submitted. Based on my inquiry of the person or persons who manage [he system, <br />or those persons directly responsible for gathering the information, the information ~ ``_ <br />~ <br />y ~ <br />O Vi/~ 1~ <br />I <br />i ~ and com lets <br />true <br />accurate <br />to the best of m knowled a and belief <br />itted is <br />b /~ , ~ ~ ~'" <br />` ~ <br />(~ . <br />, <br />, <br />, <br />, <br />su <br />m <br />f <br />i SIGNATURE OF PRINCIPAL EXECUTIVE ~b *' <br />TYPED OR PRINTED ormat <br />on, <br />I am aware that there are significant penalties for submitting false in <br />including the possibility of tine and imprisonment for knowing violations. OFFICER OR AUTHORIZED AGENT AREA NUMBER <br />CODE YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments Here) ~ ~ ~ ~ ,T ~ ~~~ T <br />"~'~~~ ~c ~'= ~._,~rvl:_T'~ ~}~I".1_ ~ v~3,~4,~~:~~ ~.1 ~,~'s'"~'s.~a~s~.~~~' a[~1.7~~ ~...~It3' ~V t~rl:a'!._~x~~: 3~'"i~ i0`~~Io'~°:~ t~ ~'~'~.~. ~' ~ ~.E~t =~' . ~. w~, <br />y~:' ; ~, "_ # 1..7 ~ ~.;i ~:{~~~.D~~',~'C1~f~i~'S. {~°~~ ~;I~Y ~latr~l_ ~ 4~s{~ :~ k~;~?'.~1.3f~,~T ~: ~'.tiy.f r-; •~. ~: , :2. ~1 I~ E' e~~' , F.•1=~ ~F y' f~':'~~^ v ~ F•~:~ ~f~3~~:~a <br /> l~ i•rt~;u`t'~-~1...~' <br />aat.°; , ~I i;~, r i`~~ ~~1=`,'~''i I_ti? ~;:°aa e"E~° s ~~'a <br />4`3:"i~`r~'+. 1 r't,~`rliiS-'fS`14"=~ait~~drn1. PAGE OF <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. P ~' <br />