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PERMITTEE NAME:ADDRESS <br />NAME <br />ADDRESS <br />:"Ar 65 <br />FACILITY <br />LOCATION f... i 816 <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) Form Approved. <br />DISCHARGE MONITORING REPORT (DMR) OMB No. 2040.00011 <br />PERMIT NUMBER DISCHARGE NUMBER F- sp,IAL RBL.AN <br />MONITORING PERIOD WASH <br />YEAR MO DAY YEAR MO DAY ` <br />FROM TO <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREDUENCY SAMPLE <br /> OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />i J I? L. V ;. REQUIREMENT <br /> SAMPLE <br />i Ei MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />i SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />'.(- REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />!?(1 REQUIREMENT : <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT atrit?{# - .? Lr ?, <br />-? _ REQUIREMENT ; <br /> SAMPLE <br />_ =r?T MEASUREMENT <br /> PERMIT . <br />r `•, slAi_I!' REQUIREMENT r:. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT - <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER mt} under penalty of law that this document and all attachments were <br />d <br />i <br />s <br />d <br />d <br />d <br />w <br />i <br />d <br />ith <br />t <br />d TELEPHONE DATE <br />/ / - prepare <br />ion or superv <br />ance w <br />ys <br />esieno <br />un <br />er my <br />ir <br />sion <br />n accor <br />a <br />em <br />to assure that quaiifted pervonncl properly gailicr and cvalu lc the intiirmatunt <br /> submitted. Rased on my inquiry of the person or personi who rnamigc the s}'sn•ni, <br />-i or those persons directiy respoa+ibie for gathering the mfonnation, the mtormatil"t - f <br />- <br />b <br />itt <br />d i <br />t <br />h <br />b <br />t <br />f <br />k <br />l <br />d b <br />li <br />f <br />i <br />d <br />d _ <br />'?. su <br />m <br />e <br />s, <br />o t <br />es <br />o <br />my <br />now <br />e <br />ge an <br />e <br />. true. ac urate.:m <br />cornp <br />crc. <br />e <br />e <br />w <br />if <br />I <br />th <br />t th <br />t <br />lo <br />f <br />b <br />itt <br />f <br />l <br />i <br />f <br />ti SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED OR' PRINTED ere are sign <br />ican <br />or su <br />ing <br />am a <br />are <br />a <br />penA <br />es <br />m <br />A <br />se <br />n <br />orma <br />on, <br />including the possibility of fine and imprisonment for knowing violation, OFFICER OR AUTHORIZED AGENT AREA <br />CODE NUMBER <br />YEAR <br />MO <br />DAY <br />MI\V GAr1../•\I\MIIV I\ Vr Mimi air <br />,.- <br />/ICIIIJ I1Cl C? <br />- o <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. 0-0157, This is a 4-part fonn.