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?ERMITTEE NAME/ADDRESS (Include FaeN6yNamelLocalion ifDicrent) <br />NIAME <br />EC <br />4DDRESS;••.-# ?-,171 °:?iri- T <br />t k =t 't 3 t^i. <br />.OCATION{. - r - - <br />NATIONAL POLLUTANT DISCHARGE EUMINAMON SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />'. L7:'..:-. / -:`•:.: i :.. ltd <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM :rt^ 1 TO v% <br />Form Approved. <br />OMB No. 2040-0004 <br />?s i t'dO <br />SUB :W <br />? %;•CHG T0 L..LJ fAS J`z\i .. <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY <br />OF SAMPLE <br /> ? TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE -r:, x=x :v-4z n i f t -r <- i . r' <br />TS _; ,:. ALE MEASUREMENT <br /> PERMIT REPOR REIF-0;s :nor- y r.rypkt <br />L JE:.I?- L -IrE.J t!' ° d?. REQUIREMENT :a Li{} t=; er rr t A;,' Y MX :'" : /? Ivr^? s .. J <br />t L' 4 i <br />T tx.. ,. SAMPLE <br />r r? J L MEASUREMENT <br /> PERMIT n r. x?M1 tx ? xµr 'f?# ??6?: F. PO <br />s tr::r r.-,rr?c • •.nt_t_ <br />Et F? • -.• . rt.•. L-_ w REQUIREMENT r. 30DA r`.%G iD.AIi.) Ili: V'GJ z- ^?i: N <br />,._ _, ... „ ? .._ SAMPLE •- -. . <br />{ ?= MEASUREMENT <br /> <br />_ t = <br />- PERMIT d=?34=?^ n ... @; nu ;f # #^? n F-EP OR a <br />- t''EFO 5 F <br />i T :- ' Yi1 7 4' i_ <br />- - REQUIREMENT r^ :?=.i s r A VG "ire _ -1-e-4 MO itii 's 2 <br />?, - SAMPLE ?? ?xwY rr?? r: <br />TO E At- R?L-v-;•?;=',; _r MEASUREMENT <br /> <br />, . <br />J PERMIT REF-OR" N*-,1E vrjFQ, <br /> <br />r. <br />` ?° .- <br />art--- r r <br />a=?7Cr rs ?r.r s- <br /> <br /> <br />EQUIREMENT <br />_ <br /> <br />Y' <br />^?r•' n j <br />^ <br />?•1,. A ?rV <br /> <br />y- :{ <br />DA I <br /> <br />r <br /> <br />r.•'r.t r.• <br /> <br /> <br />E4.Iv4Ii-I <br />_. ,?. SAMPLE t a z ={ n' • xF'. r? ??' ( e-t°v '• <br />0TFe_ I EC 1,_ ,fEF?-,B! F MEASUREMENT <br />... .. ?. '. ;% :s PERMIT :4•`-..: ?t :x-.?,L 'SI-?'•'F:#7e r3,. - .?,1• -"t. y3'3!':'i•:SZ - .' Rt. E i"• -'.'. •.R : RE-F+..3 rfi,'. i 1. 51vT..? 5..71'•!S?'.?.r=, <br />°'03S Srf:,:« REQU[REMENT <br />>GUG <br />D-AILY €•:J: <br />vSL <br />MONTI-i <br /> SAMPLE :ra=?scr n:z:t #? ?k^ i c• <br />V EF4. F_3 L i- MEASUREMENT <br />- PERMIT :i•;i- :r ':#?:. <br />:i-i ?-?• r•ck•i?••?±i••?• 7=•:EF- 0;i <br />'" •i <br />n t <br />i <br />• i\35:.E <br /> . . . <br />? <br />. <br />Ci= l k_i}??` ' GROSS VA^ REQUIREMENT <br />4r"1 t? •Y L. i'? ?.rl'kT "k <br />_ <br />....- , .._ .__ . SAMPLE 28) <br />{ OTA-r_ R=-C#sv`A L-= MEASUREMENT <br />,ti PERMIT <br />t-?= <br />; ..r : a• <br />?c?E <br />?r <br />i'Ei?t°i- <br />?'Er 1i: t <br />t <br />f4#E!` <br />??S'fi?F7 <br />r_? ^L's FEi'. t GROSS S;AT_*%,j._ REQUIREMENT <br /> <br />??JEr AV, <br /> <br />n}Ri.:F '? 3 f`+E <br />I - <br />1?" l ? <br />MONTH <br />PRINCIPAL EXECUTIVE OFFICER ' <br />NAMEITITLE PRINCIPAL EXECUTIVE OFFICER chments were <br />s document and all atta <br />chments were <br />I certify under penalty of law that this <br />d <br />i <br />i <br />i <br />d TELEPHON E DATE <br /> es <br />gne <br />sion in aecordaucc w <br />th a system <br />Prepared under my direction or superv <br />OAJLI <br />6A <br />G <br />? 6yFH <br />5 to assort that qualified personnel properly gather and evaluate the information <br />1 <br />'?? <br />l f/ <br />` submitted. Based on my inquiry of the person or petons who manage the system, <br />!? or those persons directly responsibic for gathering the informatiaa the infotmation <br />? <br />/ <br />?r <br />1i <br />/ ?Coo <br />and complete. <br />submitted is <br />to the best of my knowledge and belief <br />true <br />accurate <br />!? <br />Q <br />O <br />Y <br />^ ,t , <br />, <br />, <br />, <br />enalties for submittin <br />false infotmatIoo <br />I am aware that there are si <br />nificant SIGNATURE OF PRINCIPAL EXECUTIV S <br /> <br />TYPED OR PRINTED g <br />g <br />p <br />violations <br />ossibilit <br />includin <br />the <br />of free and im <br />risonment for knowin OFFICER OR AUTHORIZED AGENT AAEA <br />NUMBER <br />YEAR <br />MO <br />DAY <br /> . <br />g <br />g <br />p <br />y <br />p ODE <br />70MMENT6 ANU EAYUantratevnt Vr ANY vtVl.rknvtva IntarerU"k;t: dirt auaertmcru-ji neut./ <br />C/ <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. 000 12 /G siy?,.? &rmPAGE OF /?