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PERMITTEE NAME/ADDRESS (1ne?Jrfrf6ryN?.?Locarlrar 1/D(Qi.wv) <br />NAME <br />ADDRESS <br />;SAllE ^v ni5 <br />FACILITY !i 51 J ;, n T f? L S U J't is u I A L <br />LOCATION 1 tt ? n L I J M? :. C-:) b144 <br />t t :. N I I t' .. it r. <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM /NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHAAGI NUMBER <br />MONITORING PERIOD <br />FROM YEAR MO DAY TO YEAR MO DAY <br />Form Approved <br />OMB No 2040-0004 <br />IC <br />NOTE' Road Irs.tntrlla h.f-. -r.,r,l.tlna this farm <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FRE OFNCr SAMPLE <br /> <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE <br /> SAMPLE <br />A <br />U <br /> ME <br />S <br />REMENT <br /> PERMIT <br />• ' <br />1 <br /> REQUIREMENT r <br /> w y y <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> t Tr <br /> SAMPLE <br /> MEASUREMENT <br />1 PERMIT r• >. :. jCa1 t Cc/ n[ <br /> REQUIREMENT <br />_ r j ll : SAMPLE <br /> MEASUREMENT <br />_ PERMIT ,. - - <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> T a' X uf.?,. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT E bQ Hi <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT i ` ... c r.. '. n <br /> REQUIREMENT I . <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER t 1eri'ly "d" Pena ty .(I.. that tlrl <br />Prepared under my directlon or supe f document and all .ttachments were <br />rvWoet in accordance with a system desi <br />ned <br />TELEPHONE <br />DATE <br /> g <br />to assort that <br />ushned <br />er <br />n <br />el <br />ro <br />ert <br />th <br />l <br />. q <br />P <br />so <br />n <br />P <br />p <br />y ga <br />er and evo <br />uait the Information <br />submitted. Based nn my inquiry or the person or pers fie who manage the system <br /> , <br />or those person, directly responsible for gathering the Information, the Information <br /> subrnltled Is• to the best or my knowledge and belief, Irwe, scrunte• and complete. <br /> I am aw." that then are slgnlfkant Penalties for submitting tale Information, SIGNATURE OF PRINCMAL EXECUTIVE <br />TYPED OR PRINTED Including the poadblety of fine and imprisonment ror knowing vlolatk m OFFICER OR AUTHORIZED AGENT CODE NUME4ER YEAR MO DAY <br />VVmmuer.• ,rev ??. ..r... r...... ?. ...- ._?....?.. r w. wr ...... wr. wa.w.••n..wn oat crater w/ <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. This is a 4-Part fon-n.