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PERMITTEE NAME/ADDRESS (include Facility Name/Location if Different) <br />NAME E~'?.`b~.r~"~F~:z~ i~l.~~i.:a ".. t~~~,.~~i~~L~~e ~..L..~ <br />ADDRESS ~{~!^~ { tCl!"d T ~'.~~`{ ~Y I S>{~ <br />FACILITY I~{&' ~ ~ ; ~U^ .€ ~~$~ ~vl ~ ~~. <br />LOCATION ~I.r(.~ ~ {~,(~ ~~ ~Y~~ <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES) <br />DISCHARGE MONITORING REPORT (D R) <br />OCDC1~3~:C3~:+:~ liw~? t~: <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR_ MO DAY YEAR. MO,. DAY <br />FROM ca a .: TO uc .,,~~,~ ~.,..~ <br />Form Approved. <br />OMB No. 2040-0004 <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, <br /> <br />EX FREQUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />€~~);,. ~~{w.•T v~~:#~r~~ SAMPLE tr~~#,•.~~r i `•x~'u:~. ~3ffr-k-~'::. .t; :7~6cs•'i,~z: Y'r~34~~SetY~~ <br />1J ~ ~~.i~G.. MEASUREMENT <br />£~~r~L>~ I. ~j ~:} .PERMIT '~~ ,; ~ ,: ~-., ~~.. _... ~ .. .. ~ , .~ _ -.. . , ~~~.~.~, •,~ }:-, <br />~t~ ~ ~,,.1.:t~4>9 e" ~:~i~i3~ s ~f~~...~..l REQUIREMENT< ;`) ,._>'c~ , ! tea;` ~-X1`"3. ~ •, ~ 3•= , <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 /> REQUIREAAENT <br />~__.-_ _ __. _ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT< <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT. <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certify under penalty otlaw that this document and all attachments were TELEPHON E DATE <br /> prepared under my direction or supervision in accordance with a system designed <br /> <br /> <br />, <br />,, <br />t <br />~ <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, [he information T-'-{~'%/~~~ <br />-+~ ' <br />~ ' <br />4~ <br />rr <br />f ~ V 1 ~~~J" I + <br />submitted is, to the best of my knowledge and belief, true, accurate, and complete. <br />SIGNATURE OF PRINCIPAL EXECUTIVE a~-y <br />r (~' /,~ -yc~J~ <br />~'''" ' `f <br /> <br />TYPED OR PRINTED I am aware that there are significant penalties for submitting false information, <br />including the possibility of tine 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 VIOLATIONS (Reference all attachments here) <br />T"~~ ~,~ ~" {_~rf~ I~ @~{3:~ l,. ~.~k ~=.9t~~`v°~:>.? s,, ~=,~~°~t..~:~~~i...~ ~f=tl t~~ t..~{E'3~'"~ ;~i'~{..~:d}~ ~L3~ '?ii~~~8~~~~~~i-!u~. ~~!~~C?~ ~~~~d~i~' - ~~'~ s.. ~:. ~F.. <br />~^ ~,a.•-•:~.~? ~=~i. rr~:'t{.~~:~F'~?~'F~I~'u~. ~wt~t2R~~'Ri..!r c.:~~~~~_ai~;~~ ~t'~{~~F°~UC:3'~:~i~lry ~• :s. ~'. ~G:r. Fw ~t. ;'~~ ~~`~ ~~i~{3 I~ ~~~f~~:.~`~ #"i~~''~i?'-~I...`~ <br />~,:*'~ %ifI•'~ ~sr= ia~R~'s':3" s--.it_°^~~i~t-i`~^it <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. ~O.~~i~0~°t~Tfi'is~s~a'4'pa'rt£f4rm. PAGE ~©F <br />