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PERMITTEE NAMEIADDRESS (include Factlln-Name-Localion ifDrfleirnr) NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />NAME DISCHARGE MONITORING REPORT (DMR) jAL ADDRESS _ f u _ A', NY! <br />Ir •- -r M1 r - PERMIT NUMBER DISCHARGE NUMBER <br />x"IrST MONITORING PERIOD <br />FACILITY <br />YEAR MO DAY YEAR MO DAY <br />LOCATION <br />FROM TO <br />Form Approved. <br />OMB No. 2040-0004 <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY <br />OF SAMPLE <br /> TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE r q <br /> MEASUREMENT <br /> PERMIT , ,r...:kst tr ... . ,. • o r .t .; # 9. O ..W CE." IR <br /> REQUIREMENT ! 1 I ?f r i~, ,; i't rlA X T M!J," '-I MIN T! 1 <br /> SAMPLE <br />0 <br />// <br /> MEASUREMENT 71) 7 ( ?,) <br /> PERMIT j r4:t •a iF 4 ::=t# it s r i(• i :r .r .r 30 45 W! Ir r ?t<Fiu <br /> REQUIREMENT 30L,;a AW, 0A f i-`r' <br /> SAMPLE <br />I <br />l <br />a- <br /> MEASUREMENT ? / r tL <br /> PERMIT 4 ter, 'fi'a fi ?t?tt :tau:t REj`l?PT CE! =F?AP <br /> REQUIREMENT ?CIS; A <br /> SAMPLE <br />u <br />t <br /> <br />MEASUREMENT <br />I <br />D. r <br />-_- <br /> PERMIT ¢ 3t+:'s## REP-113T <br />t,lal REQUIREMENT .,I v G <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ID TOT : Nv H A <br /> REQUIREMENT 1 - <br /> SAMPLE <br />i j P ? MEASUREMENT ti • CU O. G' J% ...- U <br /> PERMIT 5.r'Of?T R?Pi.)Rl a # # -r ter#7r ## t ## zv C) T i.N 'cif; iUf <br /> REQUIREMENT Tls?IL•J f'?:? <br /> SAMPLE , ?r ( , z a #st <br /> MEASUREMENT O O ' V <br /> (J <br /> PERMIT ?k!f# REPORT C 74 -t ic.Fi+'f3F ttihiE# =fa?t# # t 1 W;:Jf_. J <br /> REQUIREMENT 1 idEiT MAX <br />, ` <br />+ .. <br />NAMETITLE PRINCIPAL EXECUTIVE OFFICER em N under penalty of law that this document and all artachmentc were <br />d <br />d <br />i <br />h <br />d <br />i <br />d TELEPHONE DATE <br /> prepare <br />er m% dircmmn or supen <br />smn in accor <br />ance w <br />t <br />a ss Stem <br />esigned <br />un <br />C•, to o<ure that qualified pcrsrmnei pti,petly gather and eealuate the mfonnation <br />` <br />s• submitted Rased tin my inquiry of the person or pcr%ons who manage the synem- / <br />? , <br />A \M <br />?• <br />? <br />r <br />` <br /> or those pers[ins directly re%yxmstbic for gathering the information. the mfonnatmn n' <br />•' <br />'"' ' <br />? <br />' <br />r <br /> <br />to the best of my knowledge and behct <br />accurate <br />and complete <br />submitted is <br />true _ <br />t , <br />, <br />, <br />. <br />. <br />I am aware that there are <br />i <br />nificant <br />rnnltic. for submittin <br />fake infurnuriun SIGNATURE OF PRINCIPAL EACUTIVE <br /> <br /> <br />TYPED OR PRINTED g <br />. <br />s <br />g <br />p <br />includin <br />the p sbahty of bite and impnsunmcm fr knnwm <br />violations <br />i <br /> <br />OFFICER OR AUTHORIZED AGENT <br />AREA <br />NUMBER <br /> <br />YEAR <br /> <br />MO <br /> <br />DAY <br /> g <br />g <br />. CODE <br />COMMENTS AND EXPLANAI IUN Ut- ANY VIULAI IUNS (Hererence au anacnmenis nere) <br />F?!:?F REC31.'Fr" ^IEc:r? <br />:!.P EVENT SUB-JECT T'; BURr}=tJ 'I!-- <br />T <br />HE DIV1S1C!N i- '. .'IN <br />EPA Form 3320.1 (Rev. 3,'99) Previous edition may be used. r)044' - Thi, 1s.a 4-pw klnn, PAGE OF