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PERMITTEE NAME/ADDRESS ilncluk Fixrlin .VutnrL.xurion /Urtrenn+l <br />NAME <br />' C? C 0;11. • L_L_C <br />ADDRESS _ .. ! IVE <br />(_?s t; <br />FACILITY I•. , <br />LOCATION <br />A <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 />r <br />MINOR <br />e r r n-n n r' r <br />Form Approved. <br />OMB No. 2040-OOD4 <br />f' - f= I t ±AI_ L.PLTE <br />srY4 rFf ?.? , :! !t7 rc t r?. , Gl1L. i I <br />NOTE: Read Instructions befo completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. • FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE t t. e is - , <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT PIA X (MILIM <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT #s s # z t, 7r tt .=sr#. 35 TO `IVi: E of : ,. <br /> <br />REQUIREMENT 3i/G; At, _ L`Ft s L r !`1 ?. 'IUN <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ti i tE#if # :: ##### 11 idEF'?41R 7 C) <br /> REQUIREMENT <br /> SAMPLE ) ! r <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT ,? <br /> SAMPLE .. ,; ,. ; <br /> MEASUREMENT <br /> PERMIT tt##li _ tr #'.f}w t ?i <br />? - O <br /> REQUIREMENT SUM <br />A DA I L. Y M X <br /> SAMPLE it . I a -4. <br /> MEASUREMENT .. <br /> PERMIT ??. i ,_ K.c :.-} rFt •. #Rfi##? ;?', t h! :. >f.• <br /> REQUIREMENT <br /> SAMPLE O:i v; c= a <br /> MEASUREMENT <br /> PERMIT REPORT <br />_ REQUIREMENT 7 AA I L-y r1i <br />NAMEITITL.E PRINCIPAL EXECUTIVE OFFICER I eentf} under p.naln of law that this dixument and all attachments acre TELEPHONE DATE <br /> prepared under mV direction or supcrN isi n m aco,rdame with a )'}'ste'm destgncd <br /> to assure that yanhilcd pcnonncl properly gather and evaluatc the information <br />' <br /> the pctson of 1wru+m who manage the system. <br />submitted. Bawd on my mqutry ur <br />the infornmtion <br />or those pemoas thrcetly resptratble fur gath King the information <br />--? -' <br /> , <br />wl <br />d b <br />lete <br />d <br />th <br />t <br />f <br />k <br />d <br />l <br />t. <br />i <br />d <br />M <br />f _ / <br /> comp <br />ine <br />ts, to <br />w v o <br />no <br />e <br />ge an <br />r <br />re <br />mc, aceura <br />c. an <br /><u <br />» <br />e <br />m% <br />f <br />n <br />f SIGNATURE OF PRINCIPAL EXECUTIVE <br /> 1 am aware that there fire sigmtka <br />t penalties for submuting <br />alse in <br />orrnauon. <br />l <br />nn -n <br />k OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br />TYPED OR PRINTED nowing t io <br />rmonN <br />g the po. tb,iny o t fine and imprisonment for <br />I CODE <br />COMMENTS AND EXPLANAI IUN Ur ANT VIUL I IvNA (nererence all anacnments nere) <br />Hit P R <br />EPA Form 3320-1 (Rev. 3/99) Previous editlons may be used. ()©©O, . .Ii11S iS a 4-part form.