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PERMITTEE NAWJADDRESSp.ebrredktyy,.?L.,.nar((nlpbea.p <br />NAME <br />ADDRESS <br />bUA L4 jV <br />FACILITY 1 1 A J '- L d i <br />LOCATION <br />Yr.0-.l:J??. r C.? U1 <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTDA (/NPOES/ <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 />C.LLCnALC Sly <br /> <br /> <br />PARAMETER <br /> <br />1>< <br />QUANTITY OR LOADING .?.?. r.w.....wu.e.roaarw o.ro <br />QUALITY OR CONCENTRATION r.-com <br />NO. pwtm9 ins. <br />FREOUNCY <br />OF corm. <br />SAMPLE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE <br /> SAMPLE <br />MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />SAMPLE <br />MEASUREMENT 1 7 S , r <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 />1 <br />NAMErnnE PRINCIPAL EXECUTNE OFFICER I crnuy under pen. y o (I.- that <br />Prepared under my dlrgcilon or w <br />er , dorvMent and all att.rhme <br />.Mon I <br />w <br />d ntf were <br />TELEPHON <br /> p <br />n s <br />c r <br />snse with a system designed <br />In assurs that qualified personnel is 0". <br />ithe, <br />nd <br />, <br />h <br />a <br />th E DATE <br /> y t <br />a <br />t <br />a <br />ss <br />. <br />e Information <br />submitted. Board on my Inquiry of the Person or persons who manage the system. <br />or those Persons directly responsible for gathering the Inrorsnatlon. the Infe'""llon <br />submitted Is, to the best of m <br />knowled <br />e <br />d b <br />f <br /> y <br />ge an <br />e <br />e <br />. true, ate.rrste. and c Pktr. <br />I am aw¦n that then a <br />d <br />Nfle <br />t <br /> <br />TYPED OR PRINTED re <br />g <br />an <br />penalties for submitting raise Information. <br />Inellndin <br />th <br />i <br />f SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br /> <br />COMMENTS AND EXPLANATION OF ANY VIOL g <br />e Poss <br />bility o <br />flee and Imprisonment for knowing violations. <br />ATIONS IR.f?r.nr? &N AffArhers-f. h-, OFFICER OR AUTHORIZED AGENT <br />AAEA ODE NUMflER <br />C <br />YEAR <br />MO <br />DAY <br />.;Lt I.s.l.?. FC)k ALlki%NAPt L11;IIAIIOAS hen <br />r:;?UlitECrLNTS - ?cE i.:;. c. <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. <br />UYii,c"+:fR PrjhCII. -.OL61 G CC <br />/ This is a A-pan