|
PERMITTEE NAME/ADDRESS ilnrludr F"din Yamellarawn if Di/farm NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES)
<br />NAME DISCHARGE MONITORING REPORT (DMR)
<br />ADDRESS Z ?)
<br />PERMIT NUMBER DISCHARGE NUMBER
<br />FACILITY MONITORING PERIOD
<br />LOCATION YEAR MO DAY YEAR MO DAY
<br />FROM TO
<br />Form Approved
<br />OMB No 2040,f)=-'-
<br />NOTE: Read Instructions before completing this form.
<br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO• FREQUENCY SAMPLE
<br />
<br />EX OF
<br />TYPE
<br /> ANALYSIS
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS
<br /> SAMPLE
<br /> MEASUREMENT
<br /> PERMIT o- .> c# rt ?? # ' i-
<br />;; REQUIREMENT r r i', I ti
<br /> SAMPLE r u. _.. ,
<br />I
<br /> MEASUREMENT
<br /> PERMIT is r - .::: k v t r yt< .
<br /> REQUIREMENT
<br /> SAMPLE ., ?_.
<br />rt_f MEASUREMENT
<br /> PERMIT
<br /> REQUIREMENT if7f:
<br /> SAMPLE
<br /> MEASUREMENT
<br />
<br />i - PERMIT .41-x.; 41 f• a. i GCS .
<br /> REQUIREMENT
<br /> SAMPLE
<br /> MEASUREMENT
<br />_ PERMIT L` of v ii ?i ?c,..•..: htc k ., tt # 3t st ,??
<br />F, i?5 Vigil REQUIREMENT
<br /> SAMPLE x## =#s _ ?#ity?+. ;?;
<br />?+ t MEASUREMENT
<br /> PERMIT # chtfi# #l f1 x ?# ####ti# 1n REPQRi i_
<br />i REQUIREMENT ?,;;: ?I LILY M l' -
<br /> SAMPLE r ir;f # ?? > Y x x et st
<br />, MEASUREMENT .'
<br />A L f)
<br />_ PERMIT ?.w# ; ., i? ?•, s •. # t r t! , - OP.! f _
<br /> REQUIREMENT
<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER Irrrtdttinder I.nah>nr1-III:11Iln.d«nrlnlll.imr.lu.uorrhminl.,..rr
<br />,,pared under rm dircbnu „r .u lx r. i.h,n .. aar„rdam a tt ilh a a wen, dnikned
<br />
<br />'
<br />TELEPHONE
<br />DATE
<br />i -- _
<br />J
<br />r
<br />"
<br />' p
<br />In :nwr IIwI .1- ifird INvn,nnn•i prep- 1, g.,11) ,r and ".I it,- Ih,- infnrmali, n
<br />h
<br />,d Ir
<br />-I
<br />il , ,d Ih
<br />-
<br />dtt
<br />n
<br />l i
<br />-n
<br />r
<br />--- N
<br />r
<br />Ihr -t
<br />l
<br />t
<br />.1 I f
<br />% . u
<br />n
<br />,
<br />l
<br />„
<br />m
<br />nyu
<br />, IN
<br />l n
<br />1
<br />. i
<br />nak
<br />e
<br />"n. I
<br />1
<br />' r Ih- pcrn m, dirtttl% for C.Ithering the mformntlnn, the m4.rmatinn
<br />41
<br />
<br />' •II11111111,d n. In 1111 IN 1 r m% I.ni,nh,tu alld heh, r m.. art llr:l it. amt r'I,n.p11.1,'.
<br />I
<br />,", -j" that thrrc trt %i
<br />nifii
<br />, n
<br />llie, G
<br />I -li
<br />illin
<br />&, mh
<br />mahun
<br />nt
<br />r --
<br />SIGNATU OF PRINCIPAL EXECUTIVE "• '•• i -
<br />-' - -
<br />- .•
<br />-
<br />TYPED OR PRINTED .
<br />p
<br />.
<br />•
<br />g
<br />a
<br />a
<br />,
<br />m
<br />g
<br />a
<br />wdudin Ih, 1 d ililt •,r fine and rn r nni,nt h.r kit-tin„ .1„Llti,an
<br />1 rN • 1 p OFFICER OR AUTHORIZED AGENT AREA NUMBER
<br />CODE
<br />YEAR
<br />MO
<br />DAY
<br />COMMENTS AND EXNLANAIIUN UI- ANT vIULAIIUNZi frtererence an arracnmenrs nere)
<br />I. t.. ii' :;a-ril\l L:• .. - ... h;- ?. C. 9. FACE
<br />?V-
<br />REASE - SEE. f C. ] S
<br />EPA Form 3320.1 (Rev T99) Preaous e4borls may be used. 0001-7 - • -I -- - 1 ?ns? .,R)rm.
|