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PERMITTEE NAME/ADDRESS (include Facility NanwILocation IfDrlferrnlJ NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />AIN FN•.. <br />ADDRESS •t. T f4F- <br />PERMIT NUMBER DISCHARGE NUMBER <br />FACILITY MONITORING PERIOD <br />LOCATION. FROM YEAR MO DAY TO YEAR MO DAY <br />Form Approved. <br />OMB No. 2040-0004 <br />HL <br />SEDZ POND TO <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 /> MEASUREMENT <br /> PERMIT IS 7. C E: / RIHLa <br /> REQUIREMENT i'IIJi'I tWt]NT! I <br /> SAMPLE ' <br /> <br />V MEASUREMENT <br /> PERMIT <br /> <br />t d <br />REQUIREMENT MONTH <br />I SAMPLE <br /> MEASUREMENT <br /> PERMIT a :.J J C F= R AP_ <br />r REQUIREMENT MLINTF <br />d <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT z ] _. ;+1I r? C! <br />- U:.' I REQUIREMENT % r{X MCiI•ITI , <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT L O r if•d i' Z!'.( .F. • ., <br />-: p - REQUIREMENT ? NI YI I ;•^. :; vE`iVT <br /> SAMPLE -'. <br />t-ic. 1 r ;.-,- • ; - - MEASUREMENT <br /> PERMIT }" t . ,! A I # #'k il• NC. _ r., <br />' <br />`' REQUIREMENT fIC7Pt1 <br />_ <br /> SAMPLE l <br /> MEASUREMENT <br /> PERMIT '• <br /> <br /> REQUIREMENT <br />NAME,TITLE PRINCIPAL EXECUTIVE OFFICER I certify under penalty of law that thins dew-tunent and all attachments were TELEPHONE DATE <br /> <br />?' LG/[s-+? S?•a.k' prepamd under tmv direction cx sufxrvmsmon to accordance with a cvstem designed <br />to assure thil qualified personnel property gather and evaluate the information _ <br />_ <br />-----' submitted. Based on my inquiry of the pcrum or per Aims who manage the %%stem. <br />or chow persotts dirwi% responsible for gathering the information, the information <br /> best of m <br />tnd F <br />accurate <br />and com <br />lete <br />submitt <br />d is <br />t <br />th <br />heG we d • <br />. ? <br /> y . <br />. <br />e <br />, <br />w <br />, <br />, <br />p <br />o <br />e <br />I <br />b <br />i <br />l <br />i <br />f <br />ti <br />h <br />i <br />f SIGNATURE OF PRINCIPAL EXECUTIVE - i : ii - 77 <br />TYPED OR PRINTED am aware that t <br />ere arc >mgril t r su <br />m <br />ng <br />a <br />n <br />orma <br />on, <br />tt <br />se <br />including the f>,xstbility o- ,in,:,n,: Mr,",•nmcnt for knowing violatioru OFFICER OR AUTHORIZED AGENT ARD CODE NUMBER YEAR MO DAY <br />I.vMMt:Nlb AnU tA?'LANAIRUN yr rani rwt..attvnQ In,nrcrcne,e an nuaenruvnw nerCJ <br />4HR REC 7 <br />Phisisa4 <br />0071 ,partforn?. <br />EPA Form 3320.1 (Rev. 3(99) Previous editions may be used.