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PERMITTEE NAME/ADDRESS J+; 'uJe Faeilin, Narneltworion IfDre•nent) NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />NAME ) DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS . ! . ' ._' <br />PERMIT NUMBER DISCHARGE NUMBER <br />AM1313iiI SPR INN MONITORING PERIOD <br />FaciuTv <br />DEN YEAR MO DAY YEAR MO DAY <br />LOCATION pEN FROM TO <br />Form Approved. <br />OMB No. 2040.0004 <br />- X <br />WOTF• Rrart Inctru(-tinnc hofnrw rmmnletinn this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE i , <br /> MEASUREMENT <br /> PERMIT 'tsEiF## #irt=#: f: fe 3??#?r ?. C Sr - <br /> REQUIREMENT T'tr =, i :'i1/1.1 <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT r <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT aa.tt # v? #D#ti?i: REPORT C `,•;ICE <br /> REQUIREMENT rDA A :-if tNT-: <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT : R+r d r * . #3r fi#ti !j 'Jf 1EiE## <br />;c REQUIREMENT _ Atir. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT n if'zus•,. :rx iSii##x r.si'rs5aE3i jt°? CINTIN ?,Cayi <br /> REQUIREMENT 71_Y M.K GENT <br /> SAMPLE i 03) #i - t r v .y a c is ;: <br /> MEASUREMENT <br /> PERMIT --PORT R.'C1R #i###•# #a: t,# #t+### 4/•r.-: ONTIN DiRPc. <br />_ ,.: ^ PGA : REQUIREMENT /i AVG t.' 11.15 <br /> SAMPLE r <r <br /> MEASUREMENT <br /> PERMIT #--2-# REPORT REPORT -RL.Y L; <br /> REQUIREMENT JS-)[)A Aly` DA I!_Y '; <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER I cert+h under penalry of taw that this document and all artachment_s were f TELEPHONE DATE <br /> i <br />d <br />di <br />d <br />d <br /> pr-pared un <br />er my <br />rection or supenteton to accor <br />th a system <br />ance w <br />estgn d - <br />\ <br /> a, a, sure that qualified personnel properly gather and evaln:ur the information <br /> suhmmed Baycd oo my inquiry of dtc pm.'on or persons who manage the rystem. <br /> or those per.wns dir fitly respon.ihle tit gathering the mtorinaucin, the information <br /> submitted ts, to the he,t of my knowledge and helief <br />true, accurate <br />and Complete. 1 I I <br />S <br /> , <br />- <br />I am aware that there are significant penalties for submnttng 146c m}ortAtioa SIGNATURE OF PRINCIPAL EXECUTIVE ' <br /> <br />TYPED OR PRINTED , <br />uxluding the powbihi•, of fine and imprisonment for knew tng violations. OFFICER OR UTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br /> CODE <br />VVMMCIY 10 MIVV CAr'LANP41 IVIV Vr /NIVT VIVL-Fi 11VIY0 InCICr CIrt:w Orr Qlttl{:lfitful Ica /rC/Cl / <br />pt)nj}Era tI F nn F' RI~fa2t17fic r <<-t,-?S <br />RECIP Fite E_NT 'rC-r r-;- <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. This- Isa 4-paq,fArm. PAGE OF