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PERMITTEE NAME/ADDRESSp.drLfattkty Na.?L-.0ia ((D(d6w) <br />NAME <br />ADDRESS <br />F_ I" <br />FACILITY JWY <br />LOCATION KEF <br />_L? <br />NATIONAL POLLUTANT DISCHAROE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHAnaE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved <br />OMB No 2040-0004 <br />NOTE: Romd Inetructfone bafcro completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREOUENCY SAMPLE <br /> <br />EX OF <br /> ANAtrsls TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT ?MIiM <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> <br /> PERMIT <br />'r l _ <br />\ ? ; Y ;:1 • <br />L' <br />I:,: r <br /> REQUIREMENT _ I <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT -; <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />t crtuy under pen. ty 0(18. that thle doturrrrnl .nd .D .11-hments .ere <br />NAME/T1TLE PRINCIPAL EXECUTIVE OFFICER <br />TELEPHONE <br />1 <br />DATE <br />preparrd under Ty di-1 <br />n or mper.l>ton In .croed.nr<.4h . systerrr dte`ned <br />1. aaurr th.l qu.ilnrd personnel Properly talker and tralaatr the Inforemllon -- <br />l <br />i <br />eubm <br />lled. Sash on .ry Inqu <br />ry of the person or prrtrone ho roamer IM fyeterrr. <br />or Ihor pmeone directly mporulble for eathertnt the Infor.ratlo., the Inforrnatlon <br />r j r mbmlltrd I& to the best M my ka..kder .M belfef• true, a mir, and rompkelr. - <br />I m ..sr. that there .rr etnmr.mt pen.trto for subrrdttln <br />r.tr Inf-ti(. <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br /> e <br />. <br />' <br />TYPED OR PRINTED - <br />-di„ t the p-dblil e M one -r imprho-1 rnr kno.I.e .tol.t,n n OFFICER OR AUTHORIZED AGENT cooE NuMeER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference aM attachments hero/ <br />rTS, > :i.'n!T fS •_??I !> It TIh nnt') <br />EPA Form 3320-1 (Rev 3199) Previous editions may be used This 1S a 4-part form. PAGE OF