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PERMITTEE NAME/ADDRESS rlnrlude ifurdut %ani,,1-,n u ,j <br />Itilprtnl, <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION 3 e <br />:1 NE <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPOES) <br />DISCHARGE MONITORING REPORT (D R) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />FROM YEAR MO DAY TO YEAR MO DAY <br />Form Approved. <br />OMB No 2040-0004 <br />)UT1 <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREOUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />4'1 <br />114 <br />I?$11?t <br /> MEASUREMENT . <br /> PERMIT <br />J ::r a <br /> REQUIREMENT l?l i NI MUM <br /> SAMPLE S I <br />!f; ?' i g <br /> MEASUREMENT <br /> <br /> PERMIT 77777777 7 <br /> REQUIREMENT - A 1^NT~. <br /> SAMPLE <%l <br /> MEASUREMENT <br /> PERMIT }._, I t _t <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT I. ` ' I ^ <br /> SAMPLE ) r_ . <br /> MEASUREMENT <br /> PERMIT ;_ &f 7LI() <br />. <br /> REQUIREMENT <br /> <br /> SAMPLE <br />N (, <br />I? <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />' ) <br /> MEASUREMENT <br /> PERMIT _ -; <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certify tinder penalty of law that this document and all attachments were <br />- <br />i <br />i <br />d <br />i TELEPHONE DATE <br /> prepared under m? dire t <br />n or supwn ision <br />n aretwdance w <br />th a -Irm <br />t's <br />gnrd _ <br />` J • . LL,1 ` {-,l ., r to assure that,1-kiied I-mnel prolwrh gather and evaluate the infonnatiott - , <br />-_ <br />- <br />l submitted. Based on ms inquiry of the peratn or pc'rvms mho manage the ,.-win. . <br />- <br /> or those persons direcll} rr•pmsibic for gathering the information, the information -•? <br /> <br />L •' <br />' - - <br />- " <br />- <br />to the 1-4 of m <br />knowledge and belief <br />true <br />anunte <br />and complete <br />sobmiutd is <br />J. <br />C <br />/ <br />, <br />_- <br />_ . <br />, <br />y <br />. <br />. <br />, <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />TYPED OR PRINTED I ant aware that then' are stgnirwaut ptmaliirs fur submitting false information, <br />itxtudiul: the li-ibifiry of fine and imprMmment for knowing vinlaUtms. <br />I OFFICER OR AUTHORIZED AGENT AREA NUMBER <br />CODE YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. 0 ' 111i,?'IS a 4-00irt-form.