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PERMITTEE NAMElADDRESS !Include FadUryNome/Location if Ihffereatl <br />NAME <br />ADDRESS ' <br />c-c$ <br />614; <br />FACILITY I Z ON I•', I P•iF <br />LOCATION i_A 0 64' 4; <br />1 ANC' I= I-JAT:F . fit T NF MAMAt--FR <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved. <br />OMB No. 2040-0004 <br />MINOR <br />( 'UBR MH ) <br />F - = I NAL f?Ni , RS <br />R&*'-i1NL i RNG7 TO CALAMITY DRAW <br />NOTE: Read Instructions before completing this form. <br />PARAMETER <br />I QUANTITY OR LOADING <br />QUALITY OR CONCENTRATION <br />NO. <br />FREQUENCY <br />OF <br />SAMPLE <br /> >< EX TYPE <br /> <br />I ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT, <br /> PERMIT ! ?i FUi' I <br />L) 77- <br />_. <br /> REQUIREMENT :3C?DA AV' L'r' <br /> <br /> SAMPLE <br /> <br /> MEASUREMENT <br /> PERMIT - f r , <br /> REQUIREMENT i; DAILY FIX >•'; <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT DA. i L. Y i•7 :. <br /> SAMPLE <br /> <br /> MEASUREMENT <br /> PERMIT _ P C, ,. _ <br /> REQUIREMENT Y Ml X <br /> SAMPLE r - <br /> MEASUREMENT -- <br /> PERMIT t # r t : 'cyt r <br /> REQUIREMENT 30DA AVG -Y Mx <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT x-; ... . <br /> REQUIREMENT '.jr t,'; DF,'.-.'! ", all-; •, <br /> SAMPLE <br /> <br /> MEASUREMENT - <br /> PERMIT 777. 177 <br /> REQUIREMENT ' (. " • .. , <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER 1 semi) under peals or taw that this document and all attachments were TELEPHONE DATE <br /> prepared under ms direction or supersisinn in accordance with u system designed _ <br /> to a-sm that yunlified poramnrl properh gather and ecaltute the information <br /> submitted. Rased on ms inyuin of the perw or person who manage the srstem• <br />-- or those persons directh responsible fur gathering the information, the information - --- - <br /> to the best of <br />owled <br />nd tidier <br />once <br />va-rate <br />and com <br />lete <br />b <br />its d is <br />k <br />e <br /> , <br />. <br />p <br />. <br />su <br />m <br />, <br />n <br />a <br />. <br />g <br />nq <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />74 I am aware that there are %i g <br />g penalties for submitting false informatitut. <br />si <br />d <br />f <br />k <br />i <br />l <br />i <br />ri <br />OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br />TYPED OR PRINTEV now <br />ons. <br />including the possihilits of <br />ne an <br />imprisonment <br />or <br />o <br />a <br />ng D <br />GUMMtIV I O ANLJ tAYLANA I IUN Ur• At`t r Ytvt_es t out Inererenc w an coat nnrenw '-.1 <br />EPA Form 3320.1 (Rev. 3/99) Previous editiorts may be used. I?Rb3g?a 4-pall fotnl.