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i-RMITTEE NAME/ADDRESS -lnrlude For•iliti 5nmrll.urvnnn i/ INffrr ntl <br />'J, ME <br />r <br />:.:.'DRESS I I4E <br />I•' %Dr?E PDAD, NO 404 <br />;VILL E <br />:ATION ,r TA .0 1 014 <br />': FNlaZ i NE ER <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER - `? <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />NnTF- Roars <br /> <br /> <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY <br />OF SAMPLE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> 4 JICF/ F. <br /> REQUIREMENT <br /> ;1ITH <br /> SAMPLE -a .? ..., <br /> MEASUREMENT <br /> PERMIT <br /> 'W I C F_ / -q,- <br /> <br />REQUIREMENT <br />REQUIREMENT <br /> % iZ%J' ITr <br /> SAMPLE <br /> <br />MEASUREMENT _ <br /> PERMIT <br /> ri.^rt T v? 1. "?? rT"f1 r. <br />?t I ,,., REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ,f <br />.. l l : <br /> , <br />:? t <br />#? j •.-' - <br /> <br />REQUIREMENT 1 7 <br /> SAMPLE <br />;?- MEASUREMENT <br /> PERMIT -- <br />1 ? <br />, <br />' <br /> r .1 <br />R i i <br />p i <br />i <br />•- ,; r z. ___ -s rs ! t <br />i'. <br />CrC., <br /> REQUIREMENT i•I <br /> X <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT -1a ;' <br />-w <br />s - <br />' <br /> r. <br />.• '1 ,. kss#:: Fi;` <br />i -1t}7r <br /> REQUIREMENT ' <br /> • .= <br />I <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT -: <br />T" <br /> l <br />q _ . f r. 7 c T^ T y R'i _ J <br /> REQUIREMENT <br /> <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER 1 "If ...... prnall' "r I"' Ih.rl uu, rb+nlnrnt and All:rn:rrhrnrnl, weer <br /> <br />I` <br />r <br />Pn-!weed under m? dira-ali.m n .ulx ru.irm in aac.,rrl?ucr a uh a -Ion dr.igned <br />I <br />- TELEPHONE <br />DATE <br />.- <br />- n aa.ura <br />IhW yualifird Iwnomld pr nhw•rh galhcr and rr nluulr Ihr infnrmalioa <br /> uhmnlyd. Ita.rd u I m, inynin of tha- p rv.n ..r ircra rn. who mm?agr Ihr ..Ha•m. <br />- .(' i/f <br />' <br />,. a <br />III-- Iw ra.nn din-ctly rr.p.nnildr tnr gadtcrmg Ihr infonnulion. Ilse information <br />.uhmiltad i <br />b <br />Ib <br />I fl - ? < <br />L <br /> ., <br />r <br />v <br />rr.t a! ma AnuwlrAl;r and Fwdirf. Inh•, urruralr, and complete. <br />na <br />am <br />r <br />• d <br />t II - i yy <br /> <br /> <br /> <br />YPED OR PRINTED . <br />a <br />a <br />w <br />I- jr, ae <br />i niGnml <br />pen:dtia4 for mbnuuhre Gd.l infnrmati„n, <br /> <br />GNATURE OF PRINCIPAL EXECUTIVE <br /> inch«IinL III,- pn..ilnlin of fn, and nnprnnomrut fnr L..-Ing ri Aatinna. OFFICER OR AUTHORIZED AGENT A NUMBER YEAR MO <br /> <br />COMMENTS AND EXPLANATION OF ANY VIOL <br />ATIONS (Reference all attachmPntc hPra) <br />CODE DAY <br />SETT '-_F.:ADLE ?iCL I DS LI" I I T WAIVED FOR 10-YR, 4•-HR PREC IP EVENT SUBJECT Tf. <br />PART I. i?. ;. ANY ADDITI1?11V41- SHAt-L BE SUPPLIED TO THE DIVISIC)N WITF <br />-_rm 3320-1 (Rev. 3•'99) Previous editions may be used r?QO_'; _ f lip 1S.' hn1}T(:1{TI'lll.