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FERMITTEENAME/ADDRESS(/nn64FodkyN.m&eLeatie ((DC#ennr) <br />NAME <br />C /1 ki r t L NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM /INPDESI <br />ADDRESS <br />60A 14 j <br />FACILITY ' TA 1D, ` / ( TU / tLl i c b <br />LOTION. .7 Z U t .? V .? : r l C V 1 n M 1 {? 1•. J <br />DISCHARGE MONITORING REPORT (DMR/ <br />PERMIT NUMBER DISCHARGE NUMEEA <br />MONITORING PERIOD <br />FROM YEAR MO DAY <br />TO YEAR MO DAY <br />Form Approved. <br />OMB No 2040-0004 <br />L 1L: --i.LCriEC '-aVtt <br />j l -. C <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREOOUI NCY SAMPLE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE <br /> SAMPLE <br />MEASUREMENT <br /> PERM <br />T <br /> I <br />REQUIREMENT -e... r L .. f i t .... 2 l: i.: . <br /> SAMPLE <br />MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I eertuy under penally o -r th,l th <br />prepared under me direction or su <br />er h documtnt and aII ¦Ilachm <br />vialon In a <br />rdsn <br />ith enb wen <br />t TELEPHONE D <br />T <br /> <br />p <br />cco <br />er w <br />• sys <br />em dudgnM <br />to a re that <br />u <br />Nfled <br />l <br />t A <br />E <br /> q <br />, <br />personne <br />Proper <br />y gather and evaluate the Information <br />submitted. Sawed on my inquiry of the person or persons who manage the system, <br />of those prnom directly responsible ror gathering the Information, the InforwuUon <br />submitted Is <br />to the Dal f m <br />knowl <br />d <br />d j <br /> , <br />y <br />e <br />ge an <br />twilef, true, and rompl te. <br />I am aware that then are significant penalties fo <br />b <br />itti <br />f <br />l <br />I <br />TYPED OR PRINTED <br />rnkAkAFNTC ANn FYPI ANATIAN AF ANY VIM r su <br />m <br />ng <br />a <br />se <br />nfr tfon, <br />Including the possibility of line and Imprisonment for knowing Holsuom <br />ATIr1N SIGNATURE OF PRINCIPAL EXECUTIVE <br />OFFICER OR AUTHORIZED AGENT A A NUMBER <br />COOE <br />YEA <br />MO <br />DAY <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used This is a 4-pas( form, PAGE OF