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PERM ITTEE NAME/ADDRESS (Include Facility Name/Location lfDifferent) <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION , <br />• a; a <br />?+ t - ti t r . .G <br />Form Approved. <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPOES) OMB No. 2040-0004 <br />DISCHARGE MONITORING REPORT (DMR) <br />llo <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD i ,' •7 , - r e'''' <br />YEAR MO DAY YEAR MO DAY <br />FROM , _ .. TO I IC , \ _ _ - .. 'd <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY <br />OF SAMPLE. <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />„kx< ! ±? , = MEASUREMENT <br />_ PERMIT :.. g ?, t rt <br />+??. ?.•__ t: c srg REQUIREMENT tr <br />tw t f. .. SAMPLE <br /> MEASUREMENT <br />i ; PERMIT <br /> REQUIREMENT € ?= <br /> SAMPLE _. .... ... - _ .. :.. _ C > :' ` <br /> MEASUREMENT <br />T + t ,? PERMIT - ?... .. ^, ¢ •.. S... .' `: <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT r • ,. r f. <br /> SAMPLE i .: .. .'?:._. K .. <br /> MEASUREMENT <br />£, PERMIT f' -' m a 1•;. ("i t. _ .. , 1. csr <br /> REQUIREMENT : <br /> <br />. , - . SAMPLE <br /> <br />?..,F:,ftl Z F',;•: MEASUREMENT <br />te•t f, f, <br />y PERMIT t 4 r:) '... f =let rM <br />wr t s ? <br />pY^ i) - w;it ^ REQUIREMENT ?,.1. <br /> SAMPLE <br />x ^`• fr MEASUREMENT <br /> PERMIT € ... .:: _ '.- .ij r .•: s :''.r >., '.: ik-'+ i.« <br /> REQUIREMENT t' t <br />NAMEJ 1TLE PRINCIPAL EXECUTIVE OFFICER I certify under penalty of law that this document and an attachments were <br />t <br />m d <br />i <br />d <br />i <br />h TELEPHONE DATE <br /> e <br />es <br />gne <br />n accordance wit <br />a sys <br />prepared under my direction or supervision <br />to assure that qualified personnel properly gather and evaluate the information <br />!per/ submitted. Based on my inquiry of the person or persons who manage the system, ,(, l• - . - <br /> or those persons directly responsible for gathering the information, the information . <br />•" .p-? ` , ?.? 1 submitted is, to the best of my knowledge and belief, true, accurate, and complete. <br /> <br />SIGNATURE OF PRINCIPAL EXECU WE <br />j <br />+" <br />N <br /> I am aware that there are significant penalties for submitting false information, <br />l <br />i OFFICER OR AUTHORIZED AGENT AR A NUM <br />ER O DAY <br />TYPED OR PRINTED ons. <br />including the possibility of fine and imprisonment for knowing vio <br />at CODE B YEAR M <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. (;r? 1S? 4-paft farm. PAGE e.. OF ` w