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PfRMITTEENAME/ADDRESS(7w"Fec-OfyNasa?Lm,arraw((DOWL w) <br />NAME <br />ADDRESS <br />• ?. QUA iy JJ <br />'SAfjL (.U blbL <br />FACILITY 4 I D i. li O K T H G S G tf : if r, i t+ :? <br />LOCATION rn LiSk J:, Ll: bi [ <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDESI <br />DISCHARGE MONITORING REPORT (D MR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM iTO <br />Form Approvec <br />OMB No 2040-GDS i <br />?JU <br />F - <br />NOTE: Read Instruction before comoletina this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. NCY <br />FREO <br />U SAMPLE <br /> O <br />F <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE <br /> SAMPLE <br /> MEASUREMENT <br />j PERMIT . •.' r. i' r r <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br />PERMIT <br />REQUIREMENT <br /> <br />NAME/TiTLE PRINCIPAL EXECUTIVE OFFICER I cernly under pen' ly ° isw that this document and alt atlwhera me were <br />TELEPHONE <br />d <br />l DATE <br />prepare <br />under ms d <br />rtetMn or wprrylslon In accordance with • system designed <br /> to assure that quaffned personnef property gather and evaluate the InformHlon <br /> submitted. Based on my Tnqutry of the person or Persons who manage the system. <br /> or those persons directly misonslbie for gathering the Information, the Information <br />'- submitted K to the best or my i,-.wge and bees/, true, accurate. and complete. -- <br /> 1 am.w.rt that there am sigMM1cant penalties for submitting false Inrormatlon, SIGNATURE OF PRINCIPAL EXECUTIVE <br />TYPED OR PRINTED Inc'luding The possibility of flee and Imprtsonme,l for knowing ytotatlora OFFICER OR AUTHORIZED AGENT <br />AREAl <br />ODE NUMBER <br />C <br /> <br />YEAR <br /> <br />MO <br /> <br />DAY <br />t,VMMCr4 1.3- ArvV [nrvsrsn I rune v. r... • .,var. , nvraa rnerarwric• air irtffcnmmta nerv/ <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used This is a 4-pert form, PAGE OF