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PERMITTEE NAME/ADDRESS t7.,&& FwotyNw.?Locarlsr (JD(Dlsw) NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM //NPOESI <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS - <br />U A 1 PERMIT NUMBER DISCHARGE NUMBER <br />G _ <br />FACILITY PER M ± (v MONITORING PERIOD <br />LOCATTOH G (•O g YEAR MO- DAY YEAR MO DAY <br />FROM TO <br />Y11OND G. DU BOISs PRES/G^, <br />Form Approved. <br />OMB No. 2040-0004 <br />MINOR <br />f "UBR <br />F• - F <br />POND <br />NOTE: Reed Instruction before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREOUENCY SAMPLE <br /> OF <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE <br /> SAMPLE <br />MEASUREMENT <br /> <br /> PERMIT ;: <, it st is ;r : t _ t <br /> REQUIREMENT -r MINIMUM MAX I MUM <br /> SAMPLE i <br /> <br />' MEASUREMENT <br />10 i PERMIT a J!D t, <br />= <br />:.DENT `i b r'; L'_ I REQUIREMENT 30DA AVC; DA T L't' MX I`10P1TH <br /> SAMPLE <br />MEASUREMENT <br /> <br /> PERMIT sir 4 - ; <br /> REQUIREMENT 30DA A`vIG DAILY Mx _ f i1_;I [T <br /> <br />(AS SAMPLE <br />MEASUREMENT <br />' <br /> PERMIT _ ?Ab <br /> REQUIREMENT ODA AVM DAILY 11h MON i i <br /> SAMPLE <br /> <br />MEASUREMENT <br /> <br />A// <br />/ <br /> / <br />- PERMIT y :•.. ,t xr <br />U P. 'N REQUIREMENT <br /> <br />-J TREA i I•.i_(-i i F SAMPLE <br />MEASUREMENT <br />,` <br /> <br />.0 1 0 O <br />PERMIT , <br />. <br />C-: C) S8 `J (. REQUIREMENT 20DA A` LILY MX <br /> <br /> SAMPLE <br />MEASUREMENT <br />- <br />- <br />PERMIT <br />AEQUIREMENT ODA AVG DAILY MX <br /> <br />NAMElT7TtE PRINCIPAL EXECUTIVE OFFICER I cenny ° r pro' Iy Law that this document and all attachments wen <br />TELEPHONE <br />pnpand coder my dlnctMm or super.ision In accordann with ° fystem designed <br />DATE <br /> to asmn that q..Nr d p.r mml prop?riy gather and evaluate the Information <br />submitted. Bred on my in <br />of the <br />uir <br />erson or <br />erson <br />wh <br />a <br />th <br /> q <br />y <br />P <br />p <br />s <br />o man <br />ge <br />e system, . <br /> or those persons dimity mitomilble roc gathering the Information, the Information <br /> submitted Is. to the best of my tmewledge and belief. Ines, arcurslr, and complete. <br />r' i - <br /> I am swan that there are slof1cmt Penalties for wtbmitting Nbe Information, SIGNATURE OF PRINCIPAL EXECUTIVE •? ' <br /> <br />TYPED OR PRMITED <br />Irst ing the Possibility or fine and Imprisonment fa knowing Aotstlom <br />OFFICER OR AUTHORIZED AGENT AAEA <br />CODE NUMEIER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND tArLArnA t tyre yr nn I wrvt.A r tvrro vrsrsrsnce an srrecnmenra neref <br />ABLE SOLIDS L TMTT APPLIED FOR -f=10YR, 24HP PPF!-TP Et/ENT- <br />-F1 -Ti;,- iN <br />EPA Form 3320.1 (Rev. 3/99) Previous editions may be used. 0007 5 / OT f9&4-P4J1jfQr M. PAGE OF