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PERMITTEE NAMEJADDRESS o..J.*,F obryNn.arL. straw UWO-!W) NATIONAL POLLUTANT OISCHAROE ELIMINATION SYSTEM //NPOESJ <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS <br />J' - { 'L` PERMIT NUMBER DISCHARGE NUMBER <br />iSADE CG I_-i <br />FACILITY DS I DF 'f j? `? ?I { TFi M T N?_ MONITORING PERIOD <br />PAL YEAR MO DAY YEAR MO DAY <br />LOCATION FROM TO <br />_-curl <br />Form App!oved <br />OMB No 2040-0004 <br />NOTE: Read {rntructione before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, <br /> <br />EX FREOUENCY <br />OF SAMPLE <br /> <br />PE <br /> ANALYSIS TY <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />r <br /> MEASUREMENT I - <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />NAMEfnnE PRINCIPAL EXECUTIVE OFFICER E f`ri'll and" pen' tT ° law that thh d« merit and .11 artarhments wen - TELEPHONE DATE <br />prepared under ml dlreetlon or mp-bit" In a Idenee with ¦ syll- dellgned , <br />f to assort 'hot qualified Fersonnrl V010061 Lather and evaluate the InfoKmatbn <br />?- w,bmltled <br />Based on m <br />In <br />uir <br />of the <br />erson or, <br />who <br />e th <br />r <br />r <br />n <br />l <br />- <br />q <br />y <br />e ses <br />. <br />l <br />p <br />pe <br />so <br />n <br />ma <br />ag <br />,,% <br />- <br />at those persons dlrerilr rvpordbk for gathering the Information. The Information - • / f <br />,f, <br />-- <br />• <br />, <br />submilted K to the belt of ml knowledge and better, true, a[turale, and tompkte. - 1a <br />? <br />'? <br />I am awan Ebel then are>Jgnlfkant penaltiel for abmitdn <br />rater Information <br />SIGNATURE OF PRINCIPAL EXECUTtVF .. - ` <br />TYPED OR PRINTED g <br />. <br />1'wcfuding the fmalblilt7 of l1w and Imprisonment for knowing rlolatlorti OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference aH attachments here! <br />SPENDED SOLIDS (TSS), TOTAL IRON AND/OR <br />EPA Form 3320-1 (Rev 3)99) Previous editions may be used <br />001 1c This is 94-part form.