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PERMITTEE NAME/ADDRESS p.&&F.db,,N.i.wL,.,,/ar (/Ddr,. w) <br />NAME <br />ADDRESS - _ Rw <br /> <br /> Q <br />FACILITY t•. , . d #r ?? <br />,? <br />LOCATION <br /> <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM //NPDES/ L4 Q Form Approved. <br />DISCHARGE MONITORING REPORT /DMRI i •,t OMB No. 2040-0004 <br />PERMIT NUMBER DISCHARGE NUh19ER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM Ut; !. TO j?• ;: :?: ?t s :_ ` HA - - <br />NOTE: Reed Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY SAMPLE <br /> OF <br /> EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE ;; 4 :1.. ,f >E :c •s .s ,.t. ;.. _ 4 >t <br /> MEASUREMENT <br />_. '. PERMIT ##tF## st?i?r?r#? •::r f?. 5 ## r?tx q C< r?°;E.t .?j-, , <br />t ?3t fi': ; -{ ] ,:i k-r?t_I REQUIREMENT:. r:,y MiNINUM MAX!MUM at.) <br />} .;.. SAMPLE -J...;•:*x r?i i i h { z f <br /> MEASUREMENT ?- <br />;;, PERMIT #s?## 3t# ; ## t -25 5 70 <br />! <br />ez <br /> REQUIREMENT .: <br /> <br />r <br /> <br />,4?, AV <br />30r <br />Mff <br />DAILY <br /> <br />M+ t <br /> <br />M?tIFF <br /> <br />i ?! .. SAMPLE <br />{ • ,T ?= ? 3 MEASUREMENT _ <br />i <br /> PERMIT # a iFiF# sh #fi3k# k si i #YF# sr# # 11 +, t qt; '.! sY ?t*.; <br />R; REQUIREMENT ?OLtF Fi°.'s DAILY M M 3iZi'7) <br /> SAMPLE % z r' 3 <br /> MEASUREMENT <br /> <br /> PERMIT irk ?t # ?t a x # tt -1 k # :? -f A..4 4 r 10 Wv t I'+ c tr ;' <br />_ ..IT './? ' REQUIREMENT <br />.;>:.: s, A I I i f l c? r' ! _ GENT <br />s .. i T -i t SAMPLE :, . <br /> MEASUREMENT <br /> PERMIT Q <br />' (}? <br />.) i ; <br />: I <br />` REQUIREMENT "C TjA AVG DAILY MX , is D ? tr sr <br />. <br />F. <br />, <br /> <br />..a <br />1 <br />SAMPLE <br />3_ .. Sr` C .,) MEASUREMENT 0 1j <br /> PERMIT 77-17 1 t tt1._Y t-rYti5 <br />- _Imo`: V,fy3_,j REQUIREMENT' 4. GR i Ft AVG UAI _Y tiX NG ... <br />` _...;.= SAMPLE <br />MEASUREMENT <br /> <br /> f'ER MiT <br />- s e 6 =i 3 ; %{1_s :'3 : ?I_#_:;. Ai l]UIREMEtVT I i?::I7 1 ?A X , tE ; =•'';• }?... <br /> <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER 1 terhly under pens ty oisw that tms docanamt and att allaehmenb were <br />TELEPHONE <br />DATE <br /> prepared under my direction or supervision In accordance with a system designed <br /> to assure that qualified personnel properly gather and evaluate the information <br />submitted. Based on my Inquiry of the person or persons who manage the system, <br />Y <br /> or those persons directly responsible for gathering the Information, the information <br /> <br />/? submitted le, to the best or my knowledge and belief, true, accurate, and complete. <br />` <br />a <br />/,n <br />- <br /> <br />C' C ! <br />1 am aware that there are significant penalties for wimilltin <br />robe Information <br />SIGNATURE OF PRINCIPAL EXECUTIVE 1 <br />V <br />V ?l7 <br /> g <br />, AIIEA <br />TYPED OR PRINTED Including the possibility of fine and Imprisonment for knowing violaUon.s. OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIQLA I IONS Ifferasnce, an arracnrrienrs here) <br />14 rf-IT <br />G t ... ..! _ <br />_ <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. ;;This '1S, a' 4-part :form. PAGE OF