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PERMITTEE NAME/ADDRESS d,,,w, Fucilire A'nn,eQocarian,j DiJ)inmr/ <br />NAME ,?;CL'? Ii?RF <br />ADDRESS !L: T <br />FACILITY <br />LOCATION <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 />tul.Jf' OMB No. 2040-0004 <br />MEDEN CR <br />NOTE: Read Instructions before conlpletinq this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO• FREQUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />SAMPLE <br />- MEASUREMENT ,.. <br />PERMIT # # x r... t : t <br />E r---, REQUIREMENT <br />SAMPLE <br />L MEASUREMENT <br /> <br />PERMIT <br />i< <br />it is <br />? i' _ r <br />t <br />7 7- <br /> REQUIREMENT ;;_ : . <br /> SAMPLE , I <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT 3'.?D?r"5`,; U M£3f: " ' <br /> SAMPLE <br />MEAS <br />REMEN l - i <br /> U <br />T <br /> PERMIT 1:11, T <br />_ <br />_ .. _ ' REQUIREMENT ,• t? ? ii= Z'- _ h i <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT _ .. -s # _•r, ?_ <br />:_ ... L' REQUIREMENT AV U; ' <br /> SAMPLE <br />L G <br />t•' i? f .i3_ MEASUREMENT <br /> PERMIT w3 t _ . r .. .. 'Itt <br /> REQUIREMENT 3rJDA :: _ [i;" -' <br />f <br />AL I SAMPLE <br />ME <br />S <br />R <br />M <br />L <br /> A <br />U <br />E <br />ENT V <br /> PERMIT :i r_ u .-- tl{ t } <br /> REQUIREMENT :; i•)1 <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER l na:, under pcnaln i law that this document end all artachmenu were TELEPHONE DATE <br /> prrparrd under my duectwn w supmtston to acctrnlame with a system designed <br />to msure that qualified personnel properly gather and evalunte the information <br />' <br />' submitted. Based un my inquir of the person or persons who mana <br />? zcrn <br />e the s <br /> g <br />y <br />. <br />or thole persons directly rcep.msthle for gathering the utfon»auon, the information <br /> suhmitted Cs, to the hest of my knowledge and bclicl' <br />true. accurate <br />and complete <br /> <br />- , <br />. <br />I am aw <br />rc si <br />n <br />f <br />n <br />lt <br />itt <br />ttd <br />f <br />u <br />re dui ther <br />t <br />f <br />r <br />b SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED OR PRINTED a <br />g <br />ican <br />pe <br />ies <br />su <br />orma <br />on. <br />i <br />a <br />o <br />m <br />ing <br />se m <br />e a <br />including the po?sththty of fine and ,mpnsonrttent for knowing vwlationi <br />OFFICER OR AUTHORIZED AGENT <br />AREA NUMBER <br />YEAR <br />MO <br />DAY <br /> CODE <br />t.UIVIMCN IJ ANV r-Ar'L 4V4MI Iv1`1 Ur hrq <br />Irrcrerence an attacnments nere) <br />171 F-- <br />EPA Form 3320.1 (Rev. 3199) Previous editions may be used. _: ? ,' _ This is=8 4-part form.