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PERMITTEE NAMEIADDRESS anclude Ewilit0tunelL cation if Uifferrim <br />NAME <br />ADDRESS <br />B 13 X c ?3 <br />r 1.0 S' <br />FACILITY LOCATION I -A 8 <br />I t.hlf F t lalfSF. t+t f hIF MANNA '?.Fi <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 />NTR5 <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT F' n7„ <br />-r _ <br />F? 1E <br /> REQUIREMENT IQL All-I.. r1±? I i `.r ... <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT r, z x r REPORT <br /> REQUIREMENT '• DA A'V U + I •_ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT I F=fl O ; <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT _ .. r-. <br /> REQUIREMENT 3GI7r3, DAILY z i.. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT :. t ?1 h?, UK I <br /> REQUIREMENT I L Y Ma <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER I eertir, under penally of Iam that this docummnt and all attachments em TELEPHONE DATE <br /> prepared under m). direction or %upenision in wrordancr nitb a ystem designed <br /> In assure that qualified Personnel properly tuner and evaluate the infurmallon .- <br />_ - - submits d. Based un m? inquire of the perwn or per on, mho manage tlw s%s(em. - <br /> or those persims direcd'i re.punsible for gathering the information. the inforruni mi <br /> wbmiwd i . to the hcH of mT knamiedge and belief. true. accurate, and complete. SIGNATURE OF PRINCIPAL EXECUTIVE - <br /> I am -re that there arc slgnirtcani penalties for whmitting fake inrormation. <br />FFI <br />R AUTHORIZED AGENT <br />R AREA <br />TYPED OR PRINTED including the possibilitc of fine and imprisonment for knnming Oolati ns. O <br />CE <br />O NUMBER YEAR MO DAY <br />COMMLNIS ANU hXPLANAIIUN UI- ANY YIVLAIIVNJ (rieterence an alfacomenis nere) <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. 00087 /