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PERMITTEE NAMElADDRESS (Include FacX0 Name/Lorahon (rDiffam) <br />NAME 1'--i j}rr,iZ .{ l:tC <br />ADDRESS CARLI0{'; ..UN TION <br />W T ,..r i 1 ,I. "T A FALLS <br />T ?. r L` •? C? <br />FACILITY }.r i3lK ;(_j..-`: ? T Y ={"•1 nj ? 13" <br />;L <br />LOCATION Yai IT?s;iyL v <br />C r C i' 330 <br />i s <br />ATTN? SAN <br />,.t l\if f"'r'. i... !-L.i't .• i"?L:_y Ti V'C. yT <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES) <br />DISCHARGE MONITORING REPORT (D R) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />Y MO.. DAY YEAR MO.. DAY <br />FROM <br />Form Approved. <br />M I NOR OMB No, 2040 0004 <br />( C-.:'vL f4 =!` / <br />F - F I r-.IAL Li t.. i <br />NOTF- Roarl Inetruetinno hef^m n-lntinn ehtn s...... <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> OF <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE <br /> SAMPLE 1 Y?1 =, 3<•x . a <br /> MEASUREMENT <br />t <br />f <br />i <br />" <br />?r(1 ?.j <br />M <br />J <br />5, ! M'' €S Kau#3(?I S #iE###. #:i <br />I <br />cFFLUch3? Fif Lr?2 VALUE <br />•REQj EIVlEl <br />rr ,1• <br />f`'III`IIl`C'LIM <br />MAXIMUM <br />SLi <br />KITH <br />? [ <br />'T LE:AkBL.E, SAMPLE #ri ?' if I rr:; r• •s<;r, <br />t <br /> MEASUREMENT <br /> <br /> <br />EFE i.tfk NT G; ZCI53S Vr';Lti 3 : #•;?• i sOL'A A VG DAILY M r,i .`L MONTH <br />0-1, L AND GRIEASE SAMPLE <br /> MEASUREMENT <br />' <br />092 <br />0 0 s`Q' ? ?i ?^?:.. ## #' 4t # elf ? s rr R ??. yb <br />,,--F'!- l Q h!? =lei) : S 'vriL? i 1 ll? Y <br />.~~ . r,,s r ?, <br />? INST MAX F-11 0 /L. ti ? {5?3 <br />1.7IyDuS i E.:3'3 SAMPLE i_'.= t :c•'?. .,s, ^n •fr T.••R•R <br />THRi3 TREATMENT F F`• NI MEASUREMENT <br />`1> E;0' s G? t1 MN<?:t <br />RtPEJRI <br /> <br />sr <br /> <br />ire <br /> <br />##;f <br /> <br /> <br />L IN MIS <br />- <br /> <br />EFFLUENT GR(M ?^ trf;LE ti" <br />w ' <br />" <br /> <br />,. . <br />:30DA AVG <br />DAILY MX <br />"fQNT}S <br />:J{ )!-- T je.. I i:) {";'.I_ SAMPLE #>k sE-?5? It r :? X r :q R Y <br />-? I ."3E, Ju. V Ei MEASUREMENT O <br /> <br /> <br />EFF LUE:VT c 1 <br />(?F?CI,.,S V4LL; <br />< <br /><. <br />300Ai AVG <br />DAILY MX <br />try t 4., AINIU r r^t`?. SAMPLE 3F' , ar 1 T t - <br />V i S UAL MEASUREMENT <br />fry <br />4. <br />t <br />lf <br />r <br />? <br />r <br />7 <br />T <br />EFFLUENT GR'.;c?,._ V; Lt.1 I Uf ST MAX NO-0 <br />C'1©!Vl'!-3 <br />. <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> <br /> <br />NAMEMTLE PRINCIPAL EXECUTIVE O FFICER I certify under penalty of law that this document and all atmchments were <br />T <br />ELEPHON <br />E <br />DA <br />TE <br /> prepared under my direction or avpervWon in a¢eordence with a system designed <br />M to assure that <br />ualiW <br />ersonnel <br />erl <br />ather and evaluate the informatio <br />ro <br /> <br />P q <br />p <br />p <br />y g <br />p <br />n <br />f <br />'a'asewr?y submitted. Based on my Inquiry of the person or persons who manage the system, <br /> <br />1// N7?- or those persons directly responsible for gathering the information, the information <br />b <br />it <br />t <br />h <br />d i <br />b <br />f <br />k p?^ ?/ ??y?? <br />b <br />o <br />o <br />I <br />e su <br />m <br />te <br />o t <br />e <br />est o <br />my <br />s. <br />nowledge and bailer, true, accurate, and complete. <br />I am awar <br />th <br />t th <br />i <br />ifi <br />t <br />lti <br />f <br />b <br />i <br />f <br />l <br />f <br />i <br />I <br />i <br />SIGNATURE OF PRINC AL EXECUTIVE / 7V <br />TTR ?OLJ 01a <br />TYPED OR PRINTED <br />rlnaaaararr& warn raver AtuATnar ^e AMW 111^1 e <br />a <br />ere are s <br />gn <br />can <br />pena <br />es <br />or su <br />m <br />a <br />se <br />n <br />ormat <br />tt <br />ng <br />on, <br />including the passibility of fine and imprisonment for knowing violations. <br />Ar1^ - OFFICER OR AUTHORIZED AGENT AREA <br />C DE NUMBER YEAR MO DAY <br />+ .i,tW t: c:sat Y: r A ., tvf\ r \. „f { tR 1-R , C _? "" i.,'E=` "NI' s?• " ;:!EST TO x3LfRrJEly OF ¢RCii3F REG Ef. *`E(\ f <br />w. L ?V <br />I?,'?' S Id <br />EPA Form 3320.1 (Rev. 3/99) Previous editions may be used. 0010 S2r`0,QS ij j? 4. & f6grm PAGE IOF