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PERMITTEE NAME/ADDRESS ,lath k Fa.•iliti Nrunc'Lc,cation ilDtfl'en•„u NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS :< pi 1 i`JE l_Ok[" t <br />B D Y PERMIT NUMBER DISCHARGE NUMBER <br />tENCE MONITORING PERIOD <br />FACILITY R N! NE L:. YEAR MO DAY YEAR MO DAY <br />LOCATION WALDEN FROM TO <br />.nr•r.nr.r t .. <br />Form Approved. <br />OMB No. 2040-0004 <br /> <br />CKSN <br />SEDI P` ND TD ILLIIVUItn MIVZn <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE ' <br /> MEASUREMENT <br /> <br />PERMIT I? G LJICF_% ('iRr <br />GR ? - VA Ui REQUIREMENT f f :1; I l MONT'i <br /> SAMPLE <br /> MEASUREMENT <br />7- Q5Iq PERMIT #?4? :th'?# }'t x ?t# REPORT 1 0. 5 Wlrt_! <br />r'F OEP4T (35'.055 `?ALUE REQUIREMENT 301-j A`.'C L' -,I. mor'lTF <br /> <br />CI I L SAMPLE <br /> MEASUREMENT <br /> PERMIT ##3t 2E# #c? rst# if#i! JF?! r ?,F; <br />r E N i G; , D 55 V F i REQUIREMENT <br />LOW, . . _ i.ir-4DU I T '_ SAMPLE <br />T HRU TREA I MENT PL's!-t- MEASUREMENT <br />. <br />irlrr50 t PERMIT REPORT ###•=r? ? r t ,, ? t it## ? :f)i.i7lPa t i?r'iJf <br />lIFN7 - „;<sl REQUIREMENT :f`1DA AVG 7iJ5 <br /> SAMPLE r A :cam ! --i > , - <br />:-i •.•. MEASUREMENT <br /> PERMIT iFsFiFiFi+;i REPORT <br />+tJG <br />i r REQUIREMENT l W5T FiF ; <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME11Tn E PRINCIPAL EXECUTIVE OFFICER I crrnfy under penalty of law that this document anti all rttachments wcrc <br />- <br />- TELEPHONE DATE <br /> prepared under my direction or supervision in aceordanec N'tth a sworn designed <br />' ' <br />-? <br />1,,?,,, <br />i char d A L171 SOTl omtatian <br />:" asure that qualified pcrumnel properly gather and evaluate the inl / . <br /> <br />id <br />. <br />P <br />A submitud. Raced on my mquin of the Perron or Person., who manage the system. <br />or those pmwns dirco v respmutstble for gathering the Infortnatton• the Informatum j ! t <br />C@ <br />re s <br />e; : tru <br />and ommplete <br />o <br />l <br />e a <br />d belief <br />accurate <br />h <br />h <br />f <br />k <br />d <br />b <br />u <br />i N 9,70 7i OE <br /> my <br />w <br />e <br />n <br />. <br />e, <br />. <br />ned <br />s, to t <br />e <br />ot o <br />n <br />g <br />su <br />n <br />f CIPAL EXECUTIVE <br />SIGNATURE OF PRI <br /> alse Information. <br />am aeare that there are significant penalties for submmmg <br />k <br />ei <br />l <br />n <br />f f <br />f <br />i <br />d <br />i <br />! OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br />TYPED OR PRINTED or <br />nowing <br />a <br />lin o <br />ine an <br />,mpr <br />.mmmcnt <br />o <br />on. <br />cluding the po-ib <br />n CODE <br />COMV,,ENTS AND EXPLANATION OF ANY VIVL.AI IUNS (rrererence an attacnments nere? <br />EPA Form 3320-1 (Rev. 3199) Previous editiors may be used. <br />.NT SUBJECT TO BURDEN OF PROOF REGUIREMENTS <br />DIVISION WITHIN 48 HOURS. <br />00_81 /ti s,ja?l 4-hail storm