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PERMITTEE NAME/ADDRESS Unclad,, Far-6y Rame/faration if Different) <br />NAME <br />ADDRESS <br />FACILITY 110R. LOCATION i-Pv <br />i A161^= IAA r%= M r6lt: M&AAI <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />I <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved. <br />OMB No. 2040-0004 <br />MINOR <br />F - FINAL Pity 1 R5 <br />r,"RnNT(-. WFT TFSTING FOR 007A ?t <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, <br /> <br />EX FREQUENCY <br />OF <br />I SAMPLE <br />TYPE <br /> ANALYS <br />S <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> <br />T'' SAMPLE <br />MEASUREMENT <br />. <br />-, _ PERMIT ,. .. ?: ,. T- . .. .. - ?. <br /> REQUIREMENT i,• ,.: t' Y <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <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 /> <br /> PERMIT <br /> REQUIREMENT <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER <br />11 of lax that this document and all attrchmrnn were <br />I mtlif> under Penal <br />prepared under m) direction nK saprnisiun in accordance with o ryslem designed <br />TELEPHONE <br />DATE <br /> to assure that yuabffed prnonnel properi? gather and evalwta the information ---- ` - <br /> submitted. Baud on my imluin of the person or person% xbo manage the 5-tem. <br />' <br />_ <br />- -' sibir for gathering the information, the Informotion <br />or lhmr per- ns direcdv resp n <br />_ •' submitted is, to the hest of m% knowledge and belief. true, accurate. and a,mpiete. <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />r r- i %• _ <br />-? <br /> I an aware that there are significant penalties for whmitting false information. <br />I <br />D <br />AREA i <br />TYPED OR PRINTED / I iwluding the passibility of fine and Imprisxnment for k-wing .Muttons. OFFICER OR AUTHOR <br />ZE <br />AGENT NUMBER <br />rnnr- YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference an arracnmenrs nere) cDURE. STARTING 1-1-09r IF THERE IS NOT A GTAT. DIFF. <br />REPORT "NO DISCHARGE" Sc COMPLETE OUTFALL 07YX. <br />EPA Form 3320.1 (Rev. 3/99) Previous editions may be used. TfiiS tSa 4-pail form. PAGE OF