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PERMITTEE NAME/ADDRESS tlnrludr l arilin ?,une l.,,,:u:,.n ,, Ilill,r,nN r <br />NAME :T1 <br />ADDRESS <br />FACILITY <br />LOCATION C <br />1 <br />-. E <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES) <br />DISCHARGE MONITORING REPORT (D R) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />FROM YEAR MO DAY TO YEAR MO DAY <br />Form Approved. <br />OMB No 2040-0004 <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO_ <br /> <br />EX FREOUENCY <br />01 SAMPLE <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />/S t <br /> MEASUREMENT 1 <br /> PERMIT <br /> REQUIREMENT !.-A ? L it'•':'•:.'=: <br /> SAMPLE - l % <br /> MEASUREMENT <br /> PERMIT _..:. ,,... ,_ .:• f _- . <br /> REQUIREMENT <br /> SAMPLE / - <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT ?CJDf? ,Aw':= DA I L.Y hIX - <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT DA I L.'Y +i' i?'•.:A .. <br /> SAMPLE <br />7 <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />s? <br /> REQUIREMENT '-,4; A V G DAILY M;=. •I',)A <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT :. c _. ,:..- . <br /> REQUIREMENT l - h i F1 _ <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER I certify undrr penalty of law that this d,avmrnt and all attaehments -ere <br />•d <br />r m <br />di <br />li <br />n <br />r su <br />ni <br />i <br />n in <br />ordu <br />• with <br />str <br />d <br />md <br />d <br />i TELEPHONE DATE <br />? ?G <br />- prtpan <br />un <br />r <br />y <br />rar <br />u <br />o <br />pe <br />s <br />o <br />am <br />ms <br />m <br />- <br />y <br />a sy <br />to wuwnv that qualiRed personnel properly Bather and valuate the infonnuliun i -.- ?- ' <br />--, <br />, <br />- - submitted. Na-td on my inquiry of the prrsan or W-ris whn manuge the system. i-?.-- <br /> or Ili- p-on, dirtclly restwmsihlt for ealhrring the information, tht information _ <br />I <br />\ <br />' <br />- - _ - •. whatitted is <br />its tht twat of in, knowledge and hi-lief. Intr <br />ucrurle <br />and complete. . j '' ( <br />L l <br />- f_. I , <br />? <br />` , <br />. <br />. <br />I <br />h <br />h <br />i <br />,fi <br />f <br />b <br />i <br />i <br />f <br />i <br />f <br />i SIGNATURE OF PRINCIPAL EXECUTIVE „ <br />- <br />- ' <br />TYPED OR PRINTED am uwarr t <br />gn <br />at t <br />rn - <br />canl penaltin <br />or su <br />m <br />tt <br />ng <br />able <br />n <br />ormat <br />on. <br />m luding the p,>`sibihp ..t rn and impriwnunent for km:-ing siolations. OFFICER OR AUTHORIZED AGENT AREA CODENUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. 0000`- 'Mis k' A 4-0iitt'P6rm.