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PERMITTEE NAME/ADDRESS .lm;r,,.+1-:rrlrn;YumLx•auoniJDifjrmnrl NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />iN'Jtrr <br />ADDRESS N Mi <br />PERMIT NUMBER DISCHARGE NUMBER <br />FACILITY MONITORING PERIOD <br />LOCATION YEAR MO DAY YEAR MO DAY <br />FROM TO <br /> <br />NOTE: React Instructions before comoletina this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT I l ] (J T I'^ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT # i•## ti it # ri #•t, , r+ ? - sit 0 =1 5 j r <br /> REQUIREMENT ?OL)f?f !'iUh I" <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT RETORT C) LJ i C, R A B <br /> REQUIREMENT A`JC D1 <br />' <br />-ION-1 <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT REP [?F.T <br /> REQUIREMENT < <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT f i.-i. #t it rc rti ?: fi i>i?r 10 10 <br /> REQUIREMENT <br /> SAMPLE Y ._ <br /> MEASUREMENT <br /> PERMIT R )-=P OF T REPORT ### if fi f; ? # s t • }t T I N L=,UR .r <br /> REQUIREMENT r> I I. 'Y Fly <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT REf'CfRT )=C)_ rvlC;-. r L <br /> REQUIREMENT 1M1:ST MAX <br />NAMErTITLE PRINCIPAL EXECUTIVE OFFICER I ccnify under penalty ,o law that this drwumertt and all attachments were <br />d TELEPHONE DATE <br /> prepare <br />under my diresnun or supereuion in accordance with a system designed <br />t <br />th <br />i <br />t <br />l <br />d <br />l <br />i <br />h <br />d <br />l <br />t <br />h <br />f r <br />'? •' <br /> o asc ure <br />if <br />pruper <br />er an <br />a <br />qua <br />e <br />personne <br />v )rat <br />eva <br />ua <br />e m <br />onnatwn <br />e t ,f <br />1 submitted. kneed on my inquiry of the pm- on or per-n5 w ho manage the <br /> or those per<om dfrecth responsfhle for gathering the information, the information <br />-< .-- <br />t UbMW I is, to the he>i If my' knowledge and hellci. true, 0erurare, and eomplefe. <br /> <br />1 , ;c that there are >,gnificant penalties fur uhmittinS faux mlinmaunn <br />SIGNATURE OF PRINCIPAL•tXECUTIVE '••rl _ /.? G / <br /> <br />TYPED OR PRINTED . <br />lin•: Jhc prr>sihility ortine.and imprisonment fw knowmu violations OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br /> CODE <br />V UPRI111 C14 10 M11 IJ CAr1?/II?IrI IVI• Vf MIS I •IWi-I IW- In C1 el CIIL,C 011 aIIOe.1 111Ia, llJ IIC, C, <br />-IP EVENT SLl[+J:•?'I TO BURDEN OF PROD', RECr1.1TFIEMENTS IN <br />PO THE D I t; I S I iIN WITHIN 4E; HOUR <br />EPA Form 3320-1 (Rev 399) Previous editions may be used. This is a 4-part €onn. <br />c