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F(RMrrTEE NAM EJADDRESS, III, uhuh facifin \:m ! <br />NAME <br />ADDRESS <br />L; I C' <br />_3P FR US <br />FACILITY ai, C: Ai <br />LOCATION =:3 <br />WERUS <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 />OMB No. 2040.0004 <br />r. <br />NOTE: Read Instructions before completing this form. <br /> NQ FREOUENCY SAMPLE <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION • OF <br /> EX I TYPE <br /> ANALYS <br />S <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT x. 1. <br /> <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT r <br /> SAMPLE j <br /> MEASUREMENT i <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE t <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br />NAMETITLE PRINCIPAL EXECUTIVE OFFICER I „'r'it` Hader pemlh> :d IAN IIIJt IIII, d land All anachinenl, Nerr TELEPHONE DATE <br /> 1-pared under m, dirmlion -n stir-s i,ion m accordance Nilh j -1rm dr,tgned <br />.. r b: x„wr Ihut qualifrld prnonnrl prnpr rh gather And & %ahwir the informah- <br />• ,uhmiued. lid nn mr m i r of the (n r,rm ur penan, Nlw mumtgr the ,,,lent. ?'-yr? <br />- <br /> or 1hrN.• ILU.nn, Jirectl? re,pon,ihle La gathering Ihr information. Iha• infnrmauon -- <br />- - -?? - <br />` ., , <br /> ,uhmiUCd i,, to the M•,1 of nn km N,ledge:tnd In•lief. trim. Aecurata•.:md complete. <br />SIGNATURE OF PRINCIPAL EXECUTIVE , C'`r? <br /> <br />' i ( I <br /> I J111 :mare 11141 the• arc <ignif-la le-n:dti- f--tmining 1.1- inforwation. AREA <br /> ri.unment for kn-ing lnlalluu, <br />h <br />hJn <br />I r <br />v <br />l m: OFFICER OR AUTHORIZED AGENT NUMBER <br />O YEAR MO DAY <br />TYPED OR PRINTED ' <br />e Ix.,`t <br />r o <br />e Ani <br />p <br />includmg t <br />i C <br />DE <br />GUMMtN I S ANU tAFLANA I IUN Ur AN T V IULA I IUPIJ (r•1t7ICf VIIOC an <br />Here/ <br />IP EVENT SUBJECT TO BUROFN OF PROW <br />U THE DIVrLSIC)N WITHIN 4 H?IUR::5 <br />;t PAGE OF <br />EPA Form 3320-1 (Rev 3.'99) Previous editions may be used This i? :1 (!3ft 1'oftll.