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PERMITTEE NAME/ADDRESS rlnrludeFwvlUr•A'amr/Lo[utfOnrJl>lffNrentt NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />NAME i J .. A T N EN, .? I r . DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS MINE <br />r rl: t'v PERMIT NUMBER DISCHARGE NUMBER <br />7- 1 <br />MONITORING PERIOD <br />FACILITY <br />- YEAR MO DAY YEAR MO DAY <br />LOCATION 'J_ .r FROM TO <br />Form Approved. <br />OMB No. 2040-DON <br />\ tiJ %J I I V YY <br />IF - F T NAI <br />z <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY <br />OF SAMPLE <br /> ? TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />- r l <br />? <br /> MEASUREMENT T / L/ mil' v U iN?kf?t s <br />7 <br /> PERMIT T REi r {, n}(';E/ rl,R <br /> REQUIREMENT IIX MONTH <br />I L) i. SAMPLE <br />Z <br />? <br />" REMENT <br />MEA -'/ <br />L'C -'U7a U ` <br />f'i=P,Tft?i'J( r' LAN; <br />rt l SU .. <br />??. j <br />t" PERMIT 1 0 <br />T <br />R O O NCE/ :-,TAPJ <br /> . <br />- . <br />EFti L.U;-_N T GROSS V REQUIREMENT :U' A r;VG rJA I I_ MONI i <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 certify under penalty of law that this document and all attachments were TELEPHONE DATE <br /> prepared under my direction ,Ir super-won in accordance with a system designed <br /> to assure that qualified pcnonnel properly gather and csaluatc the information -" <br /> submitted. Rased on my inquiry of the person or persons who manage the system, <br />or those persons directly responsible for gathenng the information. the mfonnauon ?? j ts?rlrs'r <br /> accurate <br />and cnm <br />ls-te <br />itt <br />f m <br />kn <br />l <br />d <br />and belief true <br />b <br />d i <br />t <br />th <br />b <br />t ° <br /> o <br />e <br />ge <br />, <br />, <br />p <br />su <br />m <br />e <br />s, <br />o <br />e <br />es <br />y <br />ow <br />r SIGNATURE OF PRINCIPAL EXECUTIVE 7 <br /> <br />16 I am aware that there are significant penalties for submtrung false mfom inw <br />i. <br />w <br />l <br />ibili <br />f f <br />d <br />i <br />f <br />k <br />t <br />l OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MQ <br />DAY <br />TYPED <br />R PRINTED or <br />nn <br />mk %Io <br />a <br />iom <br />uding the poss <br />ty o <br />ine an <br />Impr <br />sonment <br />inc CODE <br />COMMENTS AND EXPLANATION OF ANY VIULAI IUN5 (mererence an arracnmenrs nere) <br />ORTED MONTHLY REGARDLESS OF WHETHER AN EFFLUENT <br />EPA Form 3320-1 (Rev. 319g) Previous editions may be used. •Tt('t15 is, a.4,part form.