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PERMITTEE NAME/ADDRESS (include Facilr{T NamelLocarfon ijDhJJoenu NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS Y'il • l_11'? <br />DC, PERMIT NUMBER DISCHARGE NUMBER <br />A MONITORING PERIOD <br />FACILITY <br />YEAR MO DAY YEAR MO DAY <br />LOCATION A FROM TO <br />MINOR <br />(SUBR MH ) <br />F - F2NAL <br />5t •Z-<M1',4E DRNG Tt <br />Form Approve,! <br />OMB No. 2040-o,;?-' <br />TL.L- ' lAW <br />Nr14 T"5 <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY <br />OF SAMPLE <br /> EX LYSIS TYPE <br /> ANA <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> • r <br />r <br /> PERMIT i,. i <br />H E F , <br />_ . .. .. <br /> REQUIREMENT AVr i:1>>Y; <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> <br />PERMIT <br />aft#ie <br />»rir R. P OR T <br />F- <br />!_ Lr I <br /> REQUIREMENT i s t? V DA 7 L Y IT <br />. <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT x. r r 'r it ? > .: b <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br />,- <br /> REQUIREMENT AV , <br /> SAMPLE <br /> MEASUREMENT <br /> . <br /> PERMIT <br /> 30DA ?AILY ' <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT :: - - I. a <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT _ <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I iertifs under penal[, idlaw that this document and.ll attachment were TELEPHONE DATE <br /> prepared under m? direction or super.ision in accordance with. s,,lem designed - <br /> cu assure that qualified perxmnel pngierh gath.•r and r,aluute, the informatirm <br /> suhmitted. Based on my inquiry or the pnrvm or person, who manage the y%Ient, <br /> arsons direeU) rtmionsibir for gathering the information. the inrormutiun <br />throe <br />o <br />•' <br /> p <br />r <br />l <br />t r / ( <br />• <br />i, e <br />e. <br />whmitt cl is. to the best or m, An-ledge and be fief. tram amtnnr, and comp SIGNATURE OF PRINCIPAL EXECUTIVE <br /> I am .ware that there arc ilanirwant penalties for submitting false information. <br />HORIZED AGENT <br />R A AREA <br />R <br />Y <br />TYPED OR PRINTED / including the q -sibilih of fine atul imprisonment for Anowina ,ioiatkm,. OFFICER O <br />UT D NUMBE EAR MO DAY <br />COMMENTS AND tAYLANAIIUrv Ur ANT vlUL-AI1UPda Inctt:rcnar all O..Oe ......".. "-/ <br />EPA. Form 3320-' Rev ?:'99i P(eViOUS edapr.S !any b!i used I his I+ ;l 11