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PERMITTEE NAME/ADDRESS dnehide Facifilr NemelLocauon if Uifferetul NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES) <br />NAME )t. DISCHARGE MONITORING REPORT (D R) <br />ADDRESS _.'•(J i <br />BOX !:28 PERMIT NUMBER DISCHARGE NUMBER <br />-A t MONITORING PERIOD <br />FACILITY 1,; E q NOR Z -_7N M -r j.410 <br />YEAR MO DAY YEAR M DAY <br />LOCATION LJtJCL? ?O 87.x: FROM - TO <br />n I we:-r- 1AAM Lwa• MTAIC MAAIA4]1=R <br />Foam Approved. <br />OMB No. 2040-0004 <br />45!111114I= iJIRIYb I t-I I v i I t-G <br />NOTE: Read Instructions before completing this form. <br />MN TRS <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREOUENCY <br />OF SAMPLE <br /> EX SIS TYPE <br /> AN <br />ALY <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />r- MEASUREMENT] <br /> PERMIT <br />- <br />N, <br /> REQUIREMENT ?,'C ^S C' t <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT a r u a i. __ _? :ter. <br /> REQUIREMENT DA I L <br /> SAMPLE _ <br /> MEASUREMENT <br /> PERMIT r rt z l.. r. y, <br /> REQUIREMENT ?01)A r <br /> SAMPLE <br /> MEASUREMENT <br />? PERMIT <br />Nti <br />lull <br /> REQUIREMENT VC <br /> SAMPLE " <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT r?j'f MOf.: <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT , <br />REQUIREMENT eta ?'•'-1 ; DA T I_Y <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I crrlih under penalu of law [hat this document and an ultacbtnen[s were TELEPHONE DATE <br />Prepared under nq direction or wpenision in wvorda„ce with a %)eIetn designed <br />-"" - <br />- . <br />to assure that qualified prrw,nnel properly gather and esaluatr the information - <br />--- -- - submitted. Based on ms inyuin ,d the perVn or Persons who nwnage the system, - <br />or thusr- Persons directil responsible for gathering the information. The information - <br />submitted b, to thr best or my knowledge and belief, true. m'xurate. and complete. SIGNATURE OF PRINCIPAL EXECUTIVE - <br />- <br />- '' I am um arc that there are significant Penalties for submitting false information. AREA <br /> siolatluns <br />sibility or fine and im <br />rismnimt for knowin <br />i <br />l <br />din <br />th <br />a OFFICER OR AUTHORIZED AGENT 1 DEJ NUMBER YEAR MO DAY <br />TYPED OR PRINTED . <br />p <br />g <br />nc <br />u <br />g <br />e p <br />s CO <br />GOMMtNIS AND tXYLANAIIUN Ur ANY VIVLAIIUNA (rierererlcu wo dttawirltCltuv iturul <br />EPA Form 3320.1 (Rev. 3!99) Previous editions may be used. 00189