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PERMITTEE NAME/ADDRESS (Include Facility Name/Location if Different) <br />NAME ~'v„.`.' r7 e:,~'(•~3 I° f:;}.:.%..4.,' '"` +..~~,~~...~'S~t`~§8~1~3 ~,.~~.r <br />ADDRESS I'~?r~} #'!+..1t~ ~' ?.Q~ a'{ 3. ~4~ <br />FACILITY ~d~~~ I•'f~~'~. s~~ l~ T''(~:I<±~: <br />LOCATION Y'fi.l~tarR CC- ~, ~~„ ;~? <br />t't,~T' f~i`4: _ ~? . 1 _c=:~`~~ ~ Ifilt~<~;+~ . I"i ~ ~°.I~ I}tt~il':~~kia~l~ <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEQB M DAY YEAR. MO., DAY_. <br />FROM vc:r ~ w Tp v+:a •-,,• :.~~- <br />Form Approved. <br />OMB No. 2040-0004 <br />r~I'~t':i~.1v <br />.r~s;•%t~. ~i'~3~' ~~~PdG ~fi^t I ~ "f"Cl 'i"t,lTTi..~C: OFD <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREG1uENCY <br />OF SAMPLE <br />_ EX' TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />Q~~.. :~#'il~.4 v~2~~~1~?~:. SAMPLE #a'?;~3£~:F~ t £i'•~ 3 .i~-u .-~•K~~. ~: Yr~;S.~;.ri..~;. ~•t~--~ ~.:: <br />'~i ~ ;~ f~~j„ MEASUREMENT <br />.~ .'` PERMIT ~, <br /> <br />. ., ... ~, ~,~-t- ~ <br /> <br />.... .. '~»c".=,„~ <br /> <br />., r. '•-~;~~, ~ a, <br /> <br />. . <br /> <br /> <br />, :~: -k~:~ <br />. <br />-, <br /> <br />. <br />~~~ L,U~~I"f €,^Is'~~~~"1 ~t~i_~~ `REQUIREMENT' •j ; t` , j'0: I'.?(~'-~ s,~'y'..~.•h' <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 />- <br />- REQUIREMENT <br />- _ -_ <br />- : <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT , <br /> REQUIREMENT . <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT _ _. <br /> REQUIREMENT: <br />NAMEITITLE PRINCIPAL EXECUTIVE OFFICER I certify tinder penalty of law that this document and ali attachments were TELEPHON E DATE <br /> prepared under my direction or supervision in accordance with a system designed <br /> to assure that qualified personnel properly gather and evaluate the information <br /> submitted. Based on my inquiry of the person or persons who manage the system, <br /> or those persons directly responsible for gathering the information, the information <br /> submitted is, to the best of my knowledge and belief, true, accurate, and complete. SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED OR PRINTED I am aware that there are significant penalties for submitting false information, <br />including the possibility of fine and imprisonment for knowing violations. OFFICER OR AUTHORIZED AGENT AREA <br />CODE <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION of ANY vIVLA nvlv5 ~Ifererence au arracnmenrs nere~ <br />.I..~~ 7x b=~: ~}:~vi:~. i ~ #~~zl_i.. t~~T~ ;~,;`=~4'~~';O ~: ~~`d"~'~...~~~1.~ ~I;'1~..?'~:: I;..~Y''f~~~" ~,~'~R__~~13 ~='i~`t~ :t. ~.3'~'~t',.~~i~t~ t'i~~":Q~" r~'si::~l~' - ~~°~ <br /> ~. t~. ~, <br />~~? ~ ~.°°~~ '~`C3~ €~~C~I:~~F.~I'~~~fitil'i"a_ '~'tF~ 7~kE..':F ~~dlui~'1..~'i?1r3 ~i~4~`t'~3.rt~'9 x~h2~ ..~ ~. ~.:tf:;r ;'~ ?t"3. =Ci ;-~tY ;~'~'C :I.~ 6-1~~3~~:~'7 t~t~l¢~4~'3~3~ <br /> Y <br />r^tdC` t'SS ilk IRit"'. ~b=~ <k'Sk" Fay= i~i'1B~"t'~"+;+ <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. ~~%'~~'~T'r~-+T~1'iS-1s~a?'4=~S~fi`~O'i'ITl. PAGE rOF <br />