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PERMITTW NAME ADDRESS <br />r!nrluJr f iirllin• A'amca.«Jllr+n i(Ui/jcrcnrl <br />NAME <br />ADDRESS " <br />FACILITY - ii- <br />LOCATION O E P US ([ i <br />.-. .•. ... .•...?. .. ,,.,r?-? -wry <br />Form Approved. POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) DISCHARGE MONITORING REPORT (DMR) OMB No. 20x0-0004 <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />' 32C, FROM TO <br />Nt fTF Read Instructions before corriotetinq this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION Np. FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT S E--KLY INSITt. <br /> REQUIREMENT <br /> 1 <br /> SAMPLE ; ; ,.. <br />r?. - MEASUREMENT <br /> PERMIT d### IEr r #•le ii #tii ##k?s 3 a RA Ti <br /> REQUIREMENT 7 - '" la V G ilr't ,. ` -. MX <br />i i(7N T <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT : #)ri- sf # # '# f REPORT Q" c <br /> REQUIREMENT ,:)VA A VG "A 1 <br /> SAMPLE - - r <br /> MEASUREMENT <br /> <br />PERMIT -'.0 iitii Ei <br /> <br />c,.. <br />DF? <br />v-i ' REQUIREMENT ti5 : •: 3t:r?f?, i"' : : ??. it ''i `' I'1I7N i <br /> SAMPLE :r <br /> MEASUREMENT <br /> PERMIT U ` <br /> REQUIREMENT CA I I _Y 1 x 1 <br /> SAMPLE <br /> <br /> MEASUREMENT <br /> PERMIT 5 ,: IEai # is #', r i it rr : r : Si # i=## # 1 -' <br /> <br />- REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT REi'URT R-FOPS t'.'.._Y I?'??; <br /> REQUIREMENT rl r-n <br />NAM YnTL.E PRINCIPAL EXECUTIVE OFFICER I certtry under penalty of l'aw' that this document and .III arachnlenis were <br />direction or super-tslon in accordance with a system de igned <br />r <br />red under m r TELEPHONE DATE <br /> p <br />epa <br />y <br />to assure that qualified personnel properly gather and esaluate the information <br />r on or <br />ersons who manage the >ystcm <br />b <br />d B <br />d <br />f th <br /> p <br />• <br />asc <br />on my inquiry o <br />e pe <br />mitte <br />su <br />the infommuon <br />on <br />ible for gathering the information <br />th <br />ctl <br />r <br />s <br />d <br /> p <br />, <br />ose pcru,m <br />ne <br />y <br />e <br />s <br />or <br />d b <br />l <br />d <br />l C `? <br />? ' <br /> comp <br />ief. true. accurate, an <br />ete. <br />subrmrted u, to the hest of my knowledge an <br />e SIGNATURE OF PRINCIPAL EXECUTIVE -/ <br />? 1 i <br /> I am aware that mere are significant penalties for submi nog false information, OFFICER OR AUTHORIZED AGENT AR <br />NUMBER <br />YEAR <br />M <br />DAY <br />TYPED OR PRINTED mck:dmg the po a,h;lity of forte and unprr nnment 61r :now ing vrolannns CODE <br />COMMENTS AND EXPLANATION OF ANY VIOLAI IUN, (HeTerence all aaacrrmenis nere/ <br />-HP PRECIF E'v+NT IS CLAIMED. EXEMPTIONS FRDM <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. oooo 1 13 k? 0 4-pamfbmi.