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PERMITTEE NAMEIADDRESS (include FacilLy Namell oration if Different) <br />NAME <br />ADDRESS 1 <br />FACILITY 7 ('? I LOIN 1`11 NE <br />LOCATION LA r;'ry X11 <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 />H 7 NnR <br />Form Approved. <br />OMB No. 2040-0004 <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREOUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT -, , r 7 :: - <br /> REQUIREMENT ". I,' j ?n ?,•1 . , <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT •r t 1 <br /> REQUIREMENT "x. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT 5 A i! ' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT ''! X <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - t - , _ <br /> REQUIREMENT _ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT )?A I L.Y °-i' <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I cenu. under penulq of law that this dmvnwna and all auachmeat, wee: <br />re <br />arrd undo mt dirntion or su <br />enision in <br />e with <br />cnrd <br />n <br />s% <br />t <br />m desi <br />d TELEPHONE DATE <br /> p <br />p <br />p <br />ac <br />a <br />c <br />a <br />s <br />e <br />gne <br /> to aewre that qualiftal Iwm)nnd prnperl'i gather and evaluate tlw information _. - ---•- ' <br />1 wbmitted. Ha%ed on my inquin of Ibc person or penom who manage the rystem, <br /> <br />1 or those fwrnonl dimcll%' resiamflble for gathering the information. the infOrmatitm <br />1 - :...• -hail)" Is, u. Ibc lw-4,d m? kn.wledge and lather, Into, amunle, and c.wnplrte. -? •- <br />I l - ' I am aware that there are si <br />nificant <br />en <br />for submiltin <br />form <br />ld <br />f <br />l <br />i <br />tion SIGNATURE OF PRINCIPAL EXECUTIVE - '- - - <br />TYPED OR PRIN D . <br />g <br />p <br />a <br />" <br />g <br />a <br />x <br />n <br />a <br />including the Ia,ssibilW of fine and impr6A,nnwnt for knowing siolalirme OFFICER OR AUTHORIZED AGENT AREA NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLA I IUN5 (xererence an anacnmenfs nere) <br />LENT - SEE ] <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. TlitAs a 4-part form. PAGE OF