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PERMITTEE NAME)ADDRESSt7nc"FarWry Ne.?Lerarterl(D(P"W) <br />NAME <br />ADDRESS ,. <br />• JA 1V .1U <br />..t?Ur_ CC b1i. <br />FACILITY J a U_ N (:.; T H G S C- L 'I r !1 t X11 S <br />LOCATION 6 ,'j t <br />Form Approved <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM INPOES) OMB NO. 2040-0004 <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER - A L r, ; el <br />MONITORING PERIOD I CGb:. t b E F. K <br />YEAR MO DAY YEAR MO DAY - <br />FROM TO <br />NOTE: Read Inetrvctiorw before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREOUENCY SAMPLE <br /> OF <br />YP <br /> EX ANALYSIS T <br />E <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />t <br />:s <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 /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br /> <br />I rtr7liY u er pen. t] o I.w that thh docnmenl end all ettechmenU wart <br />NAME/T1TLE PRINCIPAL EXECUTIVE OFFICER <br />TELEPHONE <br />e <br />DATE <br />prepar <br />d on&r my dlrertlon or suptr.hlon In accordance with a sysltrn dal/ned <br />-- to awit- that quehn d personnel properly telher and tteluale the Inforntalloo <br />submitted. Bred on my inquiry or the person or <br />erswu who mana <br />e th <br />t <br />p <br />g <br />e sys <br />em, <br />or those persona dlrertly responsible for gathering the Infornullea <br />the Informats- <br />, <br />rb <br />ilt <br />d h <br />t <br />the bnt of m <br />kn <br />wl <br />d <br />m <br />e <br />o <br />y <br />o <br />e <br />_ . <br />, <br />ge and belW. true, ami-tc end rompkle. <br />I am.w.r. that ther..re cignlncani pta.nla roc submllting hlsr Inro-ti.n <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br /> . <br />l <br />r <br />i <br />h <br />n A A <br />TYPED OR PRINTED nahrd <br />nr t <br />i, o <br />t po.,lbi <br />nnr and Imprison m ror t-1.1 .W.U- OFFICER OR AUTHORIZED AGENT NUMBER <br />CODE YEAR MO DAY <br />COMMEN 15 ANU [rrl-ANA I tun yr nr. r . rv?ts r rune Inwr?rtrrrctt wr inocnrntrnta Here/ <br />.. .s4tiA F&LCZr. E?cAi L;::CU?.?? SUBJt"Ci IC 6LFLtN Cc FhCCF <br />EPA Form 3320-1 (Rev, 3/99) Previous editions may be used r This is. a.4-pan form.