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PERMITTEE NAME/ADDRESS Include Faeilin Namell .canon if l)ifferrnti <br />NAME <br />ADDRESS <br />{; X28 <br />1: 0 f <br />FACILITY Z17'N 1`111.41- <br />LOCATION A f f 1 <br />r,nsc r_ I_hnnc MTt\iL Mnhtnr?r <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR M DAY <br />FROM TO <br />MINOR <br />. r+r I-- kar I <br />F - FINAL <br />:aft&MINE TRNC- TRIB <br />NOTE: Read Instructions before completing this form. <br />NTRS <br />PARAMETER QUANTITY OR LOADING <br /> <br />I QUALITY OR CONCENTRATION NO, FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENTi <br /> PERMIT <br /> REQUIREMENT aV DA <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT :'07A f=+V:r_ DA I L.' (i J <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT :. ' <br />* <br /> REQUIREMENT I L Y <br />MX <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT rt L+ .: 1., ... <br /> REQUIREMENT AV(- DAILY MY <br /> SAMPLE <br />I <br /> MEASUREMENT <br /> PERMIT - <br /> REQUIREMENT' -ODD I +: <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT _ r' Li 1 r, i_r t <br /> REQUIREMENT M)( <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT 77 , . : .. y .t :. . , r- I-, k 1 1-1 -i i <br /> REQUIREMENT "r.: 1 .f - <br />NAMEITITLE PRINCIPAL EXECUTIVE OFFICER I rertir under penatt) of haw that this d«-ument and all attachments were TELEPHONE DATE <br /> Prepared under my direction or supers ision in accordance with a %%stem designed <br /> to assure that qualiried personnel properly gather and rs aloatc the information '- <br />- -- - - submitted. Based on my inquio or the person or Persons who manage the system. <br /> or those pees- directh responsible for gathering the informatiom the information <br /> d h <br />t <br />nd c <br />t <br />d <br />lk <br />L t <br />l ' <br />_ rue.: evuru <br />e. a <br />omp <br />e. <br />submitted is- to the best of m% knowh <br />ge an <br />e <br />• <br />e SIGNATURE OF PRINCIPAL EXECUTIVE - <br />- <br /> I am aware that there am significant Penalties for submitting false Information. AREA <br /> rii nm,ni for knowing siohations. <br />ihilit <br />or li <br />nd im <br />i <br />th <br />a <br />e <br />h <br />fi OFFICER OR AUTHORIZED AGENT NUMBER <br />CODE YEAR MO DAY <br />TYPED OR PRINTED p <br />n. <br />n <br />ng <br />e l <br />rs <br />n <br />a <br />t <br />COMMENTS AND EXPLANATION VI- ANY VIL/LAIIU1Nb (Mererence an arracnmenis neret <br />Form Approved. <br />pMB No. 2040-0004 <br />EPA Form 3320.1 (Rev. 3199) Previous editions maY be used. J ?'F?iA:?it -patC tOrtn.