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PERMITTEE NAMElADDRESS t/ncluda Facr6r -v u,., rI LUat- :+' NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS hf I t i 1= <br />$L7Y PERMIT NUMBER DISCHARGE NUMBER <br />:H ENC tE MONITORING PERIOD <br />FACILITY AR R M . . , YEAR MO DAY YEAR MO DAY <br />LOCATION JALDEN FROM TO <br />tr-ncsr.= - ., <br />Form Approved. <br />OMB No. 2040-0004 <br />MINOR <br />(SUBR !?? ) <br />F - FINAL sCKSN <br />POND F'TRTP TO 71 ANADIs"I. T <br />A <br />NOTE: Read Instructions before completing this form. <br /> NO FREQUENCY SAMPLE <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION . OF <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />r SAMPLE :< 1• <br /> MEASUREMENT <br /> PERMIT ?F #:, - < r `r s? ?. V i?iIl.E! FC! 'i <br />f REQUIREMENT MA x 1 lLIM h1Cl!4T; i <br /> SAMPLE r.; <br /> MEASUREMENT <br />:?0545 l 0 0 PERMIT i?EPORT ( n. <br />'=Fi L N' ROSS VAL.'}= REQUIREMENT .# * A AVG DAIII'y _ <br />IL AND C' i° SAMPLE r r i # <br /> MEASUREMENT <br />);• ,f<? PERMIT -#?# tr r.r.>: t it #3F sr## ;?1 ?AB <br />F " UFI REQUIREMENT d_ r r'i <br />i LOW, >V S T C; R. SAMPLE <br />7 A i l`i--NT PLAN i MEASUREMENT <br />?l 0 PERMIT T ?1:. #####3 ti #?i i' t?#: Ili! ,t::GRDi" <br />?RQSS VALU: REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />1 PERMIT t t: s: # tt R! r' f F , s ## > # r tf # st # # 1` t v: ' _ - _ A <br />77: 1 1>~? r ( REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER 'certify under penalty of law that this din umem and all attaehmcros were TELEPHONE DATE <br /> prepared under my direction or supervision in accordance with a system dowsed <br /> <br />Richard A. y,,,un1 On to assure that qualified personnel properly gather and evaluate the nrformanon _ <br />h <br />d <br />t <br />d B <br />d <br />f <br />h <br />Vi <br />id <br />t submitte <br />ase <br />on my utqutr) o <br />e person or persons w <br />o manage <br />ie sys <br />em. <br />t <br />the information <br />or those persons directly responsible for gathering the information <br />en <br />ce ire e , <br />nd com <br />lete <br />b <br />to th <br />b <br />t <br />k <br />d b <br />f <br />true <br />ccurate <br />it <br />d <br />f <br />l <br />d <br />li r? <br />r'70 - ' 338 <br />Off <br />01 <br />05 <br /> p <br />. <br />ts, <br />es <br />o <br />now <br />ge an <br />e <br />. <br />. a <br />, a <br />su <br />m <br />te <br />e <br />my <br />e <br />e SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED OR PRINTED I am asure that there Irre significant pclralGes for submitting false inGmra;:,,n. <br />reputing the possibility of fine and +mpnsonment for knowing eiolaunms OFFICER OR AUTHORIZED AGENT AREA <br />CODE NUMBER <br />YEAR <br />MO <br />DAY <br />GUMW1tNta AIVU CArIJirvAIIUN yr ANT VI%J.tsIIvrV0Ir7Crttrof mm all aglow it manta rrorc/ <br />-ECIP E <br />Tt. <br />EPA Form 3320-1 (Rev 399) Previous editions may bE Ln• <br />