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PERMITTEE NAME/ADDRESS (faelu&FaeWfyNasoWLoearfow IJD(Gm# NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM //NPDES/ <br />NAME DISCHARGE MONITORING REPORT /DMR) <br />ADDRESS D.=A- N[j 3 M i INI : 004 t l <br />F. n. rZ 0 'i rt ; Sir n? PERMIT NUMBER DISCHARGENUMBER <br />FACILITY i `i='+za -- 1 MONITORING PERIOD <br />i...rl: r+(a. _, I7 iii 'V aL V <br />YEAR M DAY YEAR MO DAY <br />LOCATIONS;.. PARR S- 1 ?Ot?, %d SafeWFROM U1 - Zj LA S TO {)rt x j j <br />(SUBR f1h ) <br />V -- FINAL <br />Form Approved. <br />OMB No. 2040-0004 <br />04.11"x! 15 <br /> <br />No DISCHARGE 1 X I <br />NOTE: Read Instnlcdorm before, completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY SAMPLE <br /> <br /> EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />r 1? SAMPLE ?? ;L i # x##?»?# Y? t k # # > 12) <br /> MEASUREMENT <br /> j <br />. s= LUL=NT GROSS VALU itfdUIREMEN7 gat its { ry7?,_;; r , t, SU <br />011-11-)S <br />Lr-'E LEABL <br />E SAMPLE i 4? it , 25) <br />. <br />_ MEASUREMENT <br />?l <br />C c ? <br />,P, 54 S ) O O .:PERMIT : €r- <br />r <br />?< t 4, r !£ ? ? , <br /> <br />t <br />' F L3_IENT UaI«;OSS VALUE .: 1tEQUIREMENT <br />............ C3L%L„ = _- <br />'. I ?I}r tirY h iiF i SAMPLE k }t !s l? 3z kr I is k a » fii'oi ? d» Gr 1t 1; !t car ) <br /> MEASUREMENT <br /> `PERMIT <br />? FLI.}Iw;NT GR(55SS VALU: REQUIREMENT trii #: ;s 1=a:° IvI(4'/ L <br />L.t??r.I: z?13 CL HDL "T OR SAMPLE A !: }?) tr I rg o'i ; F xr d R ii B d:- i <br />T;-RL' '1"REA 11EN-i PL.ANI MEASUREMENT <br />. sU. 3 ...I PERMIT <br />L 1 1??T G135^1?.,S V ;L.U P..... VIREMENT " i •' . ri ?;. M.01) <br />'+:`GLal'S, ••il•S`i•AIL. SAMPLE is c I it.? ?£ zti •# ) 3 <br />;D I 6 SOLVED MEASUREMENT <br />?15 I U?+ t? PERMIT <br />4.£; '?° <br />_ :' iz':R > . 7..' <br />Sad •?:• iC• <br />E5 '; ?' r <br />... ?'? <br />- <br />_ <br />1.F FLUENT GROSS VALU AEOU WMENT Y; I??rL <br />'.AIL AP3D t'::REDt E SAMPLE ii iiticiitw Y :?r ) ii?..",..izPi r:L i? ig•x tirxr <br />I S UAL MEASUREMENT <br />1 Q 0 PERMIT : <br />t L-UFNT GROCIS VALUz REQUIREMEN'T'' a ?? <br />No= o H <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ' <br /> AE(1UIREMENT <br />NAMEMnE PRINCIPAL EXECUTIVE OFFICER t cerhty under Penalty o law that th <br />prepared under my direction orsupe is document and all attachments were <br />rvhlon in accordance with • system designed <br />TELEPHON <br />E <br />DA <br />TE <br /> to assure that qualified personnel properly gather and evaluate the Information <br />. submitted. Based on my Inquiry of the person or persons who manage the system, <br />^ <br />-` or those persons directly responsible for gathering the information, the information <br />/ <br />o ' submitted h, to the best of my knowledge and belief, true, accurate, and complete. ,\ <br />b <br /> <br />I am aware that there are significant penalties for mbrNtting Ube Into <br />rmation; <br />SIONATLRE Of PRINCIPAL EXECUTIVE w <br /> <br />TYPED OR PRINTED <br />Including the possibility of fine and Imptiaonment for knowing v1olsdons <br />OfFICER OR AUTHORIZED AGENT ARE <br />CODE <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EArLAfvn I ION OF AN v •tvt.ra I Ivrva /Mararence, an afracnmenrs nerd <br />S.i"c._`r?il '_L Ica #_);fdl'4 6"'1'LI`Ot =9G?'liE'kt-1 r?Ft'G?.I'J€q!1" - SST i1:'tf_ SOLIDS LIMITS WAIVED 1'd?C3frtt <br />x.1..1 '€3 •3 '-'VENT - ?y"t`":C€? fili){?`i'IT_s1^G"f i' ,t44 of A. ,. OIL }'e G?'EASE f??:lY?'IN" -- :3 :E,: 1. V. 1. A. C? DAY AI f?ljC <br />r ...?,.y r ,;•?t Est a ?_;••. s`_? :z in RtMr-f.: <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. ?, 1 ^c f -This?is 3=.4-part10rm. PAGE OF