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PERMITTEE NAME/ADDRESS (Include fardity AnmelLxution if 9iffe"nti <br />NAME <br />ADDRESS <br />FACILITY I ijH 1. ZU;J 1 i i I'•IL <br />LOCATION _F1 C. U 614 '4 <br />LANCE WAl.'E, MIT•,IE MANAGER <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 MO DAY <br />FROM TO <br />Form Approved. <br />OMB No 2040.0004 <br />MINOR <br />(SUBR MI-i ) <br />IF - FINAL. i.NTR5 <br />SR&PI! E L'RNG TRIS TO CALAMI'l"r' <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION N0. FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT1 <br /> PERMIT <br /> REQUIREMENT r 1! G DAILY MX <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT "Z , <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT :.. t- _ r<tr <br /> REQUIREMENT DA F `•' RAIL-Y" fix <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT xx,t -7r- , 7771F. 1 :c,•,.:fr _ <br /> REQUIREMENT %?`•,'= DA I i_ V <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT a i. it i- :. t _ 1. • - <br /> REQUIREMENT '--.171 DA AVG <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT Y , :;. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ...:. , L: <br /> REQUIREMENT ; <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER t crrtit. under prnultr of law that this document and all attachments were TELEPHONE DATE <br /> prepared under m's directiin ar sullershion In aeenrdance with a ?y stem desigtnd <br /> to assure that qualified W-nnrl properi, gather and evaluate the inrormatim - -'-? <br /> %uhmiliM. Ita ed on m" inquiry of the Weston or pe-tms who manage the system. j <br /> or those perst- dinrlh resprmsible rose gathering the information, the information ' -. <br />j- submitt•d is. to the hest or my Knowledge and belief. true. accurate, and complete. SIGNATURE OF PRINCIPAL EXECUTIVE <br /> I am aware that there are signifwam Penalties far wbmitting false informatinn. <br />h <br />wi <br />si <br />d <br />ti <br />d i <br />t f <br />K <br />OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br />TYPED OR PRINTED anmen <br />no <br />ng <br />a <br />um. <br />including the pm%ibilit% tor fine an <br />mpr <br />or <br />, CO <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />EPA Form 3320-1 (Rev. 3M) Previous edi ions may be used 7niis-lia'4-pact f(wm.