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molar-?? <br />Form Approved. <br />PERMITTEE NAME/ADDRESS paeM6faeiMryNaasart oeaHar IJD(Q .rest) NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM- WDES/ OMB No. 2040-0004 <br />NAME - DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS <br />} 75P PERMIT NUMBER DISCHARGE NUMBER t\;a\L t .q. P SER <br />3 <br />J: } f„ fµL '7 ;°aft s1?+•.f'1>:5,*' ,. ?? t'ltt 17 ?. t. ;S"??,`•'..?t..l f'?1 "- T <br />r t ="' cc - MONITORING PERIOD <br />FACILITY <br />YEAR MO DAY YEAR MO DAY <br />LOCATION"at FROM o f.j vf? TO Qi - i:: aeE ` ??Y i t`u'G ? 3i i t <br />NOTE: Rasd Instructions beforsl c;rnplstin9 this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> AVERAGE MAXIMUM UNITS. MINIMUM AVERAGE MAXIMUM UNITS ANALYSIS <br />p SAMPLE <br /> MEASUREMENT <br />+ is PERMIT tr a + _; ?k:T x z i. f.? ?, 2 >? •7,? s? (' 1 z: "-:._.'t I f?4'__3 T , <br />t}1 t <br />t? `= { (#EdU1REMEN7 r :r.i - 11: t f 1: th! ri1 Fr; i (it?Y '.' <br />_ SAMPLE S i .. _.:1 (••. ! - r?t 3 7?'1 :t sh xi >' <br /> MEASUREMENT U <br />t't!= r' .x O PERMIT x t?. <br />.C^1' 1 (iilti4 r?I:•a `i VIA 1JT REQUIREMENT i'. DAll- 'r' NX '? fti: N <br />0 _ i`'•, J!2 i.13, . '== SAMPLE i t! a ;..!•`.. F zv # =.?3' <br /> MEASUREMENT <br /> PERMIT *4-,, * f i # <br />E' Mfr f l i : REQUIREMENT =t' <br />J <br /> SAMPLE <br />T ^RU T t ' MEASUREMENT <br /> <br />?00 s0 r r <br />PERMIT <br />R t: i ?p r <br />t7 t1{ i <br />? ? 3fi ?•'sf ? <br />f t sx # st # <br />{ r <br />::L FIB:; !=fit} ,_r?7 tp REQUIREMENT l". C4:6 <br />_I :,, •r r SAMPLE 4 91 <br />` f L <br />V ` MEASUREMENT <br />I PERMIT <br /> REQUIREMENT. t`14y .- <br /> SAMPLE <br /> MEASUREMENT - <br /> PERMIT <br /> R PUIREMEN`f <br /> SAMPLE <br /> MEASUREMENT <br /> f'ERMtT <br /> REQUIREMENT <br />AME/TITLE PRINCIPAL EXECUTIVE OFFICER t certtty under penalty o law tha this document and oil attachments were <br />t <br />d <br />i <br />d <br />i <br />h TELEPHONE DATE <br />N a sys <br />gne <br />t <br />em <br />es <br />prepared under my direAlon or supe. v on In accordance w <br /> to assure that qualified personnel properly ether and evaluate the Inrormation <br /> submitted. Based on my Inquiry of the person or persons who manage the system, <br />& <br /> or those persons directly responsible for gathering the Information, the Information IeL_ <br /> submitted Is, to the best of my knowledge and belief, true, accurate, and complete. <br />RINCIPAL EXECUTIVE •? ? <br />r <br />?,/ G I am aware that there are significant penalties for submitting false Information, SIGNATURE OF P AREA <br />NUMBER <br />YE <br />R <br />MO <br />TYPED PRINTED Including the possibllltyof fine and Imprisonment for knowing vioIsdom. OFFICER OR AUTHORIZED AGENT CODE A DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS /Refivrencs s// attachments hero) <br />?S`'-:;'7 <br />-r-"? <br />'.? <br />i <br />{" <br />t <br />+ '}; t•?+1 .-• ia:.. «?I.....:Y:...':.a.+i.., <br />••L !.', <br />=f: b?.vv ,....'?7 tom: tyA. !> <br />. <br />• <br />. <br />a.. .., i <br />i:? - <br />1 : <br />,.,.,1 i3 .. <br />, <br />- <br />i JC '1.A*_' 011110 <br /> _ <br />•, , . _, .. _ :. - - :_ <br />t <br />This IS_a+ aq fgrtn. <br />OF <br />PAGE <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used.