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PERMITTEE NAME/ADDRESS i1,ic.WeFacidn•NontetLoralioerfrmpe1am1 <br />NAME ; IN EERG I NC. <br />ADDRESS <br />U164$ <br />FACILITY i <br />LOCATION . •Y O 8164$ <br />i A), °;, T `4 r' MA?rJA FQ <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br /> <br />_AN <br />NOTE: Read Instructions before comOletinq this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />Ft SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT i <br />. SAMPLE <br /> MEASUREMENT <br /> PERMIT * :- 2 C, J . ; , s 16 • # si ii y s <br /> REQUIREMENT f`+G Plf, <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 /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I --fy under penalry of law that this document and all attachments were <br />i <br />d <br />t <br />di <br />•i <br />d <br />i <br />h <br />d TELEPHONE DATE <br /> <br />S <br />? prepare <br />rect <br />sion in accor <br />tin <br />er my <br />on or supcn <br />ance w <br />t <br />a systcm <br />edgned <br />to assure that qualified personnel properly gather and c%aluate the mformalwit - <br />?G Ce .?.e S ? submitted- Based on my inquiry of the person or persons who manage the system. <br /> or thou persons directly responsible for gathenng the information, the mfntmatum, " <br /> <br />L' <br />submitted is <br />to the Nast of my knowhdge and belief <br />true <br />accurate <br />and complete <br />-2 y <br /> , <br />, <br />. <br />, <br />. <br />1 am aware that there arc si <br />enalties for submittin <br />false information <br />nificant SIGNATURE OF PRINCIPAL EXECUTIVE V <br />TYPED ( PRINTED g <br />p <br />g <br />including the possibility of fine and impnsonment for knowin <br />violations OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER YEAR MO DAY <br /> g CODE <br />Intrivitlllt:C all agiat:IJIIIvIIeJ ritittry <br />OF I i- ::i i <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. This is a .tempt form.