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PERMITTEE NAME/ADDRESS iM.1W, Fmain .%'amc-2 wimv,IfI)Ifjenaq <br />NAME <br />ADDRESS L-GADOUT <br />C:U 8122 <br />FACILITY i i-iL" f I T NE "DAL L"O DOUT <br />LOCATION OR ENCE i:0 8122 <br />.('?F7rF' t.J P.? fT'=?Cr"1A1. r_Cnt M/hG <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 />Form Approved. <br />OMB No. 2040-0004 <br />'UNL1 1 DSGHF?G T ;0LtM 1.1 <br /> <br />PARAMETER QUANTITY OR LOADING OUAUTY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> OF <br />TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS <br /> SAMPLE Y <br /> MEASUREMENT <br /> PERMIT '?#### t# x ?, 5 ###St# NCE/ IN.. <br />i?! JE REQUIREMENT <br />!M <br />MONT>- <br /> SAMPLE t: `t tJ ; <br /> MEASUREMENT <br /> <br />. ? PERMIT 641, ## =;. I # >, . <br />REPORT <br />O. 5 <br />NCE! <br />RED <br />F .' L.+Ji-' AL_: REQUIREMENT T?C3DA AV,- DAIL 'y Nk MONI Fi <br />=tit SAMPLE - a <br /> MEASUREMENT <br /> PERMIT j) CINTIN -? <br /> REQUIREMENT L- GENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT r}-PORT REPORT ###### s.4x:. - - .:: :. <br />JNt; :. <br />I• ;: <br />F FL `Jr' REQUIREMENT .DA AVG «T.LY I'1 MONTH <br /> SAMPLE r i't 4 # # ( k r a[ ; <br /> MEASUREMENT <br /> PERMIT .1yy? REu(;R,f F__? i ;r### ##??### NC / I,>V <br /> REQUIREMENT I NST MAX 1'' _ MONTH <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I cartrfy under pen,Jty t•f taw that mts ducurtnnt and all attachrmuLs werc TELEPHONE DATE <br />_ prepared under my dtrcction ur .uperviston m accordance with a system destgned - i --? <br />I? <br />R, C t 1 to assure that ytuthficd personnel properly gathrr and evaluate the tnfornutrron <br /> <br />submitt <br />d <br />Ba <br />%W <br />s <br />i <br />f th <br />h / <br /> <br />- "' <br /> <br />: e <br />- <br />- <br />on m <br />tnqu <br />rv o <br />e person or persons w <br />it uuutage the system. <br />or thou pcrscnu dir th• rctiprmsihle <br />for gathering the uuimn.mun. the infitmtation <br />- <br />k <br />. _ submmitted rs, to the hest of my kno, ledge and beliel. true. accurate, and complete. <br />I <br />h SIGNATURE OF PRINCIPAL EXECUTIVE <br /> am .tuarc that t <br />ere are signift<.m.. patalnes for suhmoung false information, <br /> <br />TYPED OR PRINTED <br />in0htdmg the pit»sbihty of fine anc impnsomrtcnt for knowing viulauons. OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br />rn Ikfi RAFNTC Akin CVDI AIJATIAtJ AC ANV %Ilnt A7Ir1\I0 In..s.......__ _rr _ CODE <br />-'T r:-_EABLr '-i0L1DS L IM: ? PRECIP EVF <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. (7Q009 1 'his, is p,4-part ffirm.