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PERMITTEE NAMElADDRESS,include Farilut 1 .,„ ur <br />NAME <br />ADDRESS Y K <br />FACILITY a? 5 <br />LOCATION rJ 1' F. ?. ,' ty?'g <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES)v F100 DrO ls_-D-3 1 Approved. 4 <br />DISCHARGE MONITORING REPORT (DMR) I, <br />PERMIT NUMBER DISCHARGE NUMBER - j DELI <br />MONITORING PERIOD ORK GUNK T EN <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />NOTE: Read Instructions before completing this form. <br />PARAMETER <br />QUANTITY OR LOADING <br />QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE ( 2 <br /> MEASUREMENT <br /> PERMIT t3F# t r ## '? rst rj ;r-## ## 0 W EEKLY 5 Ij <br /> REQUIREMENT a.#-# M I ^J I I''1' 'r? i1<?,; f If_.'19 <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT c### 4 # x# a :: x 35 7rJ <br />12 <br /> <br />C ! <br /> REQUIREMENT 30DA AVG (7Fa `! `i .'. •' MONTH <br /> SAMPLE + t#:: <br /> MEASUREMENT <br /> PERMIT #3~ #iF't #. x ail#TtiE# REPORT V' <br /> REQUIREMENT = 30DA DA I L - <br /> SAMPLE - ( i <br /> MEASUREMENT <br /> PERMIT ##+! ####iEii # f ll# ##IF### '?. 5 t . . <br /> REQUIREMENT 'k 3C)DA AV'. DAILY MX <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT q3t#### *..4 a -:.ate t #tr#?i## 3. 5 7. O IVCE/ r'-1r <br /> REQUIREMENT 30DA ,a'/ t- Y P; X r M[?NTH <br /> SAMPLE - # x <br /> MEASUREMENT <br /> PERMIT #?'.E#:># #'k#:r;:sE sf t??<> i##### fir r# 0 <br /> REQUIREMENT ; s DA T L-'-" <br />-1 ; <br />, . <br />7 <br /> <br />GENT <br />,i SAMPLE <br />- I MEASUREMENT <br /> PERMIT RF°ORT REPORT i:r -r f•#itr.tfi iF# f-r- I n I- W EEV'_ 5TAN <br /> REQUIREMENT AVG DAILY MX <br />NAME,TITLE PRINCIPAL EXECUTIVE OFFICER mi unde-r penatry of la% that this document and all attachments were TELEPHONE DATE <br /> <br />?! (: ,y--r f? /•? - prepared under mp direction or supervision to accordance with a system designed <br />to assure dwi quahtied personnel properly gather and evaluate the information ? <br /> submitted Based tin my inquiry of the person or persons who manage the system. , - <br />l, or those persons directly nspatsible for gathering the information. the information <br />^ submitted is <br />to the best of mq knowledge and belief <br />tam <br />accurate <br />and com <br />lete <br /> , <br />, <br />, <br />. <br />, <br />p <br />I am <br />t th <br />th <br />i <br />ifi <br />lti <br />f <br />b <br />o <br />f <br />l <br />i <br />i SIGNATURE OF PRI CIPAL EXECUTIVE <br /> <br />TYPED OR PRINTED aware <br />a <br />em are s <br />gn <br />cant pena <br />or su <br />u <br />nmg <br />nformat <br />es <br />a <br />se <br />on. <br />including the pomihihty of fine and impnsonment for knowing violations OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />M <br /> CODE O DAY <br />4-HR PRECIP EVENT lb CLAIMED. EXEMPTIONS FROM <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. ;.D000 ; ThNs 1S'a-4=prt form.