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<br />PERMITTEE NAME/ADDRESS pwei si,r dbtyN.ndL«arrar IJDomti <br />NAME _ <br />ADDRESS... • r. <br />FACILITY <br />LOCATION._: ?r id I i 'i sT `1cL <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM I(NPDESI O? EPml Approved. <br />DISCHARGE MONITORING REPORT (DMRI % ?-- I g P ,21MB No. 2040-0004 <br />J lei}° i T_' <br />PERMIT NUMBER DISCHARGE NUMBER ' ' <br />a. . <br />7 rs...t T?.i,_,y <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY L <br />FROM '.A s:i ! r? i t TO <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, SAMPLE <br /> EX E TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />- SAMPLE 4,? 4'.r.. i <br /> MEASUREMENT <br />ID PERMIT ??.+?### #r-?? t # R s:?x: 6. S ?4x-? 9. 7 l? 7. <br /> IREQUIRWENI" ; •i; 4 1-11 N I P1UH NA x I mur-1 _i <br />L.. . f c . e3i..l SAMPLE N 717 <br />( =7 <br /> MEASUREMENT <br />y1 ' PERMIT *.k -=' 4:__K ???t ? _ ?r t>>? <br /> AEQli1REMENT <br />DAILY" MX <br />;r, .' <br />i IJD ? T <br />i" <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> <br />PERMIT <br />tf # # # # <br /># # l # <br />t: {:.' <br />ti # ii it <br />x it ?t 10 <br />!, t <br />rs :.; <br />_.._ r t t?) f l'?? ;" vAt.l IL REQUIREMENT <br />?. <br />i .. I Wi T NAX GENT <br />t.iR SAMPLE <br />"pl.C t.i i I`t _zrq ; MEASUREMENT <br /> PERNIfT RiC Qfi RE .CIR T #?r# # k it k v lit t ## # is i. :.C.%:1 _ 1 'J,? t ?,t^ <br />;J:r REQUIREMENT :7 D, M A V G DAILY MX <br />r' •.•. , , •.. SAMPLE x „ <br /> MEASUREMENT <br /> l EFIMIT ?r k? 4r it it <br />1; <br />k. <br /> <br />KAU x <br /> <br />3 • ?4L Y <br /> <br />rrsf ?°, <br />. .= . r`-s,4-c"'ss.., c''<? ;ii_ AEt1UiREMENT i, ;J 1 ?, r=?= C DAIt_Y Flit fi??i=; <br /> SAMPLE <br />?' [ MEASUREMENT <br />- `?• f r •: PERMIT is i # PORT F'5= I <br />i? # sR a <br />i :< <br />1, s y <br />L, r <br />° ij ;T REQUIREMENT I PJST MAX ' )...... ; <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ; <br /> REQUFIEM(:fJT <br />ITLE PRINCIPAL EXECUME OFFICER r certny u er pens ty o aw that this document and all attachments were <br />TELEPHONE <br />DATE <br />NAME/T prepared under my direction or supervision In accordance with a system designed <br /> <br />_ to assure that qualified personnel property gather and evaluate the Information <br />submitted. Based on my inquiry of lbe person or persons who manage the system, <br /> 'or those persons directly responsible for gathering the Information, the information - <br /> submitted le, to the best of my knowledge and belief, true, accurate, and complete. 7 - 5, U <br />-- C( I am aware that there are si <br />nificant <br />enalties for submittin <br />false Inf <br />ti SIONATURE OF PRINCIPAL EXECUTIVE " <br /> g <br />p <br />g <br />orma <br />on, <br />TYPED OR PRINTED Including the Possibility of One and Imprisonment for knowing vlolstlom. OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION vl- ANT VIVLA I sons werorsnce sn srncnmenrs nors/ <br />-- - <br />I''..d_..i_ 7 1 ,73 <br />_:,i, <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. This 1S a4-part_fOrm. PAGE -OF