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PERMITTEE NAME/ADDRESS Nnclude facility Nmnr4warion if Different <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />c3i7? <br />17R;=riR <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />I <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />FROM YEAR MO DAY TO YEAR MO DAY <br />Form Approved. <br />OMB No 2040-0004 <br />F - <br />n?;r y <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 />?tTl <br /> MEASUREMENT <br /> <br />PERMIT r t <br /> <br />.: <br /> REQUIREMENT <br /> SAMPLE y ! 1 ?tilJ - _ ;1< <br /> MEASUREMENT _ <br /> PERMIT t 7'1"= -;• rii_ <br /> REQUIREMENT J L:. <br /> SAMPLE <br />OAS <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />r <br />' J <br />14 <br /> MEASUREMENT - <br /> PERMIT ;; . <br /> REQUIREMENT <br /> SAMPLE <br />( <br />`- <br /> MEASUREMENT - J <br /> PERMIT <br />. <br />F. <br /> REQUIREMENT <br /> <br /> SAMPLE <br />e y <br /> MEASUREMENT n-0 <br /> PERMIT <br /> REQUIREMENT r <br /> SAMPLE <br />? <br /> MEASUREMENT <br />3 ?? (per <br />a <br />-jQ <br />L I <br /> PERMIT , : r 1 r; ." _ <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I crrtd. under penalty of law that thk d-ument and all attachment. Mere TELEPHONE DATE <br /> prepared under m% direclinn ur wper%ision in accordance with a -Itro dniyned , . ?. <br />-'r i to aswrr that yualifird prnonnrl properly gather and er aluate the informat <br /> ion <br /> or thou persons directly r-F-%ible for gathering the information. the informution - _ - ,-, <br />` t <br />d co <br />let <br />l <br />d <br />d b <br />li <br />f ` <br />C <br />V <br />l ge an <br />e, an <br />mp <br />e. <br />wbmitt d i.. m the hmt „I - f.nuw <br />e <br />e <br />e <br />, lrua. uccuru SIGNATURE OF PRINCIPAL EXECUTIVE <br />TYPED OR PRINTED I am ..are that there or, signirwant penal i- for whmitting rule information. <br />itwhtding the pmsibdity of riot and imprisonment for Amawing riulationE OFFICER OR AUTHORIZED AGENT <br />l AREA <br />corl, NUMBER YEAR MO DAY <br />COMMEN15 ANU LAPLANA I IUN Ul- ANT V IULA I tvn0 (eTererence du attacrnnerns rterel <br />EPA Form 3320-1 (Rev. 3/99) Previous editions <br />"x. Pa 4. >`r]R REf_tU ?rM; <br />I'fti, i, a -1 rllt '(,I I;; 'At L OF