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PERMIITEE NAMEIADDRESS (include Faeilay Namd(ocatian if Differetut <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION i <br />r.n,r-t. t.lr.T1C r+tTr•t>= rvt?nlnr_•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 F-71-- I <br />Form Approved. <br />OMB No. 2040-0004 <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY <br />OF SAMPLE <br /> <br />EX <br />ALYSIS TYPE <br /> AN <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> '7f <br /> PERMIT 7- <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br />f ; <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT e DA I <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> r <br /> PERMIT <br /> REQUIREMENT <br />TLE PRINCIPAL EXECUTIVE OFFICER I srrtif) under pet itt of law that this dlKmffim :Ind a0 atutchment? Nefe TELEPHONE DATE <br />NAME/TI Prepared under ma direction or wpenisiom in il-ordanee with j ,,,ten designed <br /> to assure that qualified personnel profterl.v gather and evaluate the information _ - ` <br /> wbmitled. Baud on nn inquin or the person or persom who manage the yrtent. <br />- - on, ible for gathering the information. the information <br />rsons dir-6 <br />% res <br />thos -" <br /> ,r <br />. <br />p <br />e pe <br />submitted is. In the best of mi ktwwledgr and Ix• W, true. accurate. and complete. SIGNATURE OF PRINCIPAL EXECUTIVE <br />' I am aN Urr that there are significant penaltirs for uhmilling false information. <br />R OR AUTHORIZED AGENT <br />IC AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br />TYPED OR PRINTED including the possibilin of fine and imprisonment for knowing viodutions OFF <br />E DE <br />nttot Inncnra ++c+cl <br />COMMENTS AND EXPLANAI IUN Ul- ANT VIULAIIUrvJ (f7CIMMIGC all <br />EPA Form 3320-1 (Rev. 3199) Previous editions may t>e used <br />24HR PREC 1P EVEN'T - SEE I A.2 <br />30 DAY AVG I5 HIGHEST MONTHL <br />00