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PERMITTEE NAME/ADDRESS (I.AA. FaeihtyN..?Lorarrem I(D(fomw) <br />NAME <br />ADDRESS <br />?F_R <br />FACILITY L' v F' nS i- <br />LOCATION ^ t' <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (WDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved <br />OMB No 2040-0004 <br />X <br />NOTE: Read kwtructIorw before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREOLIENCY <br />SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT ",: r? X I Ml: f ! <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT , ...r <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT _ <br />- <br /> REQUIREMENT `1-. <br />)NT i <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT % <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ., . _. _, <br /> REQUIREMENT -%+'I <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER I cenny under penalty o flaw that this donrment .new .uachmrnu were TELEPHONE DATE <br />Prepared am kr my dlrertlon or wpen•hlon In accerdanrr with • fyalem dexitned <br />to aware that quatt6eti pe-wi property gather and evaluate the Information <br />1 fabmllted. Board em my Inquiry of the peram or person who manage the eyrtrn, <br />or thoaa prrwm directly reepomflbk fa gathering the Information, the information <br />bell of m <br />ktawlyd <br />bmitted k <br />to th <br />nd b <br />t <br />' <br />L <br />tt <br />r <br />t <br />d <br />su <br />. <br />e <br />y <br />ge a <br />e <br />e <br />rue. a m <br />. ; <br />. <br />.. an <br />compki.. <br />• <br />" I am aware th <br />t then are at <br />nlflramt <br />enalef <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />f <br />rb <br />lld. <br />f <br />ke Inform <br />ti <br /> g <br />p <br />a <br />e <br />or w <br />m <br />1 <br />a <br />a <br />on. J WAl <br />TYPED PRINTED Including the posalbluly 91floe and Imprivoement for ttmowing rWatko OFFICER OR AUTHORIZED AGENT Aoo <br />N1)11WR YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Refivence aM attachments hers) <br />EPA Form 3320-1 (Rev 3199) Previous editions may be used This is 1 4-part (Orin. PAGE OF