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PERMITTEE NAMEIADDRESS (Include Facility Namell ocation if Different) <br />NAME <br />ADDRESS <br /> <br /> <br />FACILITY ;t:.irl.!3..,;r <br />LOCATION P , <br />S1i... <br /> <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES) <br />DISCHARGE MONITORING REPORT (D R) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM R O:, TO <'.. 'l°'' <br />Form Approved. <br />OMB No. 2040-0004 <br />:t 1 <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO• FREQUENCY SAMPLE <br /> OF <br />TYPE <br /> EX ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />MEASUREMENT <br /> PERMIT <;- s <br />t 3 ;•I s;r_r' c e 7- REQUIREMENT t t t <br /> <br /> <br />'N SAMPLE <br />MEASUREMENT = r. <br /> <br />( R , <br /> <br />J•? <br /> <br />t <br /> <br />?i ?f <br /> PERMIT :... f • . c :.... - '=i t ".' ." a t° <br /> REQUIREMENT r <br />?x.ut <br />. -• SAMPLE ? .. ,. :?? , .. .. . , r ... ,. ? ? 4 a <br /> MEASUREMENT <br /> PERMIT % <br />t»:`'.1 ly. -?"°?'_t3;•. REQUIREMENT <br /> SAMPLE <br />MEASUREMENT {S...c. r <br /> PERMIT <br /> <br />REQUIREMENT % <br /> <br />? .r <br /> SAMPLE =P t ...,.u.. <br />! } <br />; <br />f <br />k <br />1„ a `:L `.. t .. <br /> <br />k $r MEASUREMENT , <br />t <br />% - F. / , <br /> <br />r ?.' <br />`c .a. •' PERMIT .., x . i .. a <br />13rr rij VAI _li ^ REQUIREMENT o .$ a ° <br />€;, , a =slit SAMPLE <br /> MEASUREMENT C ?? V Ci N?r <br />Q PERMIT -. :•.3; -.. F... <br /> REQUIREMENT r 6 :, l:;' f <br />ti?,,,•, r. SAMPLE <br /> MEASUREMENT <br />c <br /> PERMIT r. ? k ...... <br /> <br />{ i'' t???i "r._•sI + ;T. <br />,:I t? J -:V <br />REQUIREMENT <br />NAMErrITLE PRINCIPAL EXECUTIVE OFFICER f certify under penalty of law that this document and all attachments were <br />d <br />d <br />i <br />i TELEPHONE DATE <br /> prepare <br />un <br />er my d <br />rect <br />on or supervision in accordance with a system designed T <br />-. , R' M ;? 4 's •J( <br />6 '? ry to assure that qualified personnel properly gather and evaluate the information <br />submitted <br />Based on m <br />in <br />uir <br />of the <br />erson or <br />ersons who mana <br />th <br />t (? pC <br /> <br />,.T . <br />y <br />q <br />y <br />p <br />p <br />ge <br />e sys <br />em, <br />or those persons directly responsible for gathering the information, the information <br />'??? "'`' -!._?'v ' <br />• <br />I <br />g f: <br />p , 61 <br />submitted is, to the best of my knowledge and belief, true, accurate, and complete. <br />I aware that there are e significant penalties for submitting false information ti <br />SIG_NATURE bFT?RINCIPAL EXECUTIVE ? <br /> <br />TYPED OR PRINTED , <br />including the possibility of fine and imprisonment for knowing violations. <br />OFFICER OR AUTHORIZED AGENT <br />AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br /> CODE <br />k,V1V11V1CIV IA A14U CArLANA 11VIV Vr AIVT VIVLAI IVIMJ (Keference alt arracnmenrs nere) <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. <br />....._ - .. c:`--= .`.'' ' . ...... _ is ? . <br />i s ,This si a 4pqv, tprm. PAGE 3 1 OF