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PERMITTEE NAME/ADDRESS(ynelr&FwotyNa%WLoeationlfD(Qllnnt) <br />NAME <br />ADDRESS <br />FACILITY <br />^ .° <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM WDESI <br />DISCHARGE MONITORING REPORT /DMR) <br />- PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM Qk: o.' V TO + i:? `:r -jQ . <br />Form Approved. <br />OMB No. 2040-0004 <br />GLIT2T e <br />1: ?, ?-i ce }.(°= <br />(-?C? T ? <br />:'?' ?i"i • ;?a7 F ' .%sC 1._ Ar" C ? r -1._ ? 'f: •Y. r. <br />NOTE: Read instructiora before completing this form. <br />PARAMETER _ QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, OF Cr <br />F <br />OF SAMPLE <br /> EX TYPE <br />1 >< AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS AN <br />ANALYSIS <br />_C5 ' t •_.' f F' < cgs f=d':k°? <br />e <br />1 'r <br />f'' <br />= <br />? <br />C SAMPLE <br />MEASUREMENT <br />' <br />U <br />G t/ <br />t <br />\ <br />. <br />, <br />>.t >i PERMIT btcs; 0 t # ?. , x <br />_ 3' 2., j.l(tr, 1?J :! I <br />• ,.t".. i:ly '?: 5 }tom itEQUIREMENT •. <br />ii SAMPLE -'• -. ;, ,., rv .?, ?: -. <br />' <br />G <br /> MEASUREMENT U v <br /> PERMIT + <br />_x4r.,_ REQUIREMENT r y; j }?v ti'r? •_ w "W 1 <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> R.EOUIREMENT» <br />........... <br />. <br />. <br />. <br />:.... <br /> . <br />. <br />: <br />: <br />SAMPLE <br />a <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> ,:. PERMIT <br /> REaUIREMEN* <br />... <br />. <br />.:::::..... ........ <br /> . <br />. <br />. <br />SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REnuIA15MEN'f <br /> SAMPLE <br /> MEASUREMENT <br /> fiE,RMIT <br /> tFCIUIREMENT <br />mnE PRINCIPAL EXECUTIVE OFFICER I eertrty ° tr pens t) o Iaw that this document and all attachments were <br />d <br />i <br />d TELEPHONE DATE <br />NAME es <br />gne <br />prepared under my direction or supervision In accordance with a system <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 />' or those persons directly responsible for gathering the Information, the Information <br />• t <br />a <br />rate <br />and com <br />lete <br />t <br />k <br />d <br />d b <br />f <br />h <br />b <br />r <br />l <br />li <br />d I 9 • t <br />)67 <br />9 0Y ol a <br />? <br />,?t <br />( now <br />rue, <br />ccu <br />, <br />p <br />. <br />o <br />my <br />ge an <br />e <br />e <br />, <br />s, to t <br />e <br />es <br />e <br />submitte EXECUTIVE <br />RIN <br />I j <br />. <br />7 <br />? <br />\dG {I 1 '0 P 1 am aware that there are significant penalties for submitting raise Information, PAL <br />SIGNATURE OF P <br />C <br />Z AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br />TYPED OR PRINTED including The Possibility or line and Imprisonment for knowing violations, ED AGENT <br />OFFICER OR AUTHORI CODE <br /> <br />..n <br />MMENTS AND EXPLANATIUN yr nn r vrvLn I rvrao Inerfnrsrecor art .c........ <br />a n.... <br />CO <br /> <br /> <br /> <br /> - This is a .4-par[ forn?. PAGE of <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. -