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PERMITTEE NAME/ADDRESS ?/nrlad, /a, il,n %a"' l:a:,n •u i; I' f/ir.nr. <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />DISCHARGE MONITORING REPORT (0) R) <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 />111N <br />`•. Sal <br />OUTT <br />F -- FINAL R <br />t?RFAC- F- REEK 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 f .1 ?, <4 y? l Ir 1 ` T1 <br /> MEASUREMENT <br /> PERMIT <br />5 I, <br />a _ <br /> <br />• r-,.. <br /> REQUIREMENT a T 1,1 r •: r1AX T ", PII?PITa- <br /> SAMPLE <br /> MEASUREMENT 7 <br /> PERMIT t <br /> REQUIREMENT f • '. 11,E 'ii A`J ' <br /> SAMPLE / <br /> MEASUREMENT <br /> PERMIT 1 <br /> REQUIREMENT PA .I <br /> SAMPLE <br />- <br /> MEASUREMENT - <br /> PERMIT <br /> REQUIREMENT = LY <br /> SAMPLE :. <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT ?.,, ;! •' TH <br /> SAMPLE ?c <br />f n( <br />y? <br />f?? <br /> MEASUREMENT <br /> PERMIT 3 i 1 t <br /> REQUIREMENT j {,; <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT = :.. .. _ t <br />I'At <br /> REQUIREMENT <br />-1 <br />-L <br />L <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certif-I under penal(. 4law that this d,Kument and all ultachments weer <br />i <br />d <br />d <br />i <br />i <br />I <br />d <br />h <br />d <br />i <br />d (` TELEPHONE DATE <br />` <br />' <br />? on <br />n uccor <br />ance w <br />a -lem <br />prrpare <br />un <br />er ms direct <br />on or supers k <br />t <br />es <br />gne <br />J ?;,. ,•? I G- <br />C <br />' . <br />- - It, -airr $but qualified perwnnel pr,perl% guthrr and esaluate the informulioa <br /> wbmiUad. Ruxd,n m? inyuin of the prrvn or p•rome who mmtege the ss arm, <br />' or those personi dim if, respnsible for gathering the information, the information C- - <br />1 3 <br />• <br />? <br />. <br />•? subinkird is <br />In the M•sI of me knowlydge and belief <br />true <br />accurate <br />and complete 1 u <br />_ i .?? • I <br />i f <br />._ <br />_ .. .. .. . <br />. <br />. <br />. <br />. SIGNATURE OF PRINCIPAL EXECUTIVE 1 <br />TYPED OR PRINTED I am uwarr that there irr hinirrcunl penxilies for wlnnitting false information. <br />including the possibilip of Fine and impriwnmrnt rnr knowing si,dutions. OFFICER OR AUTHORIZED AGENT AREA NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />c 'Thitiin: a 4- 6lrt form. <br />EPA Form 3320-1 (Rev. 3x99) Previous editions may be used.