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PERMITTEE NAME/ADDRESS rfncfude Facifit•Y.%'amr/f oeation if Ilifferenti <br />NAME <br />ADDRESS _ <br />cre <br />FACILITY <br />LOCATION <br />NATIONAL POLLUTANT DISCHARGE EUrdR;ATiON SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Approved. <br />''r••,: No, 2040.0004 <br />is <br />5ULR <br />F IROUTT <br />3LIRFAC` -C: TR131 -• <br />Nf1TF• Raari Inctriartinne hafnra rmmrilatinn this fnrm <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> OF <br /> EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> <br />MEASUREMENT / <br />{- <br />i ?+ <br />VI- -;tY <br /> PERMIT t r ; -A r• _, r . 7+_ iL. <br /> REQUIREMENT -! TH <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I tea-tiff under Ixnalt% of haw that thi%document and all attachments were i j TELEPHONE DATE <br /> prepared under nay direction or.upenision in accordance with a syslem de.ignrd r_ - _ '-?Y- <br />- <br />_ (?% - - r ? <br />? to &-re that yuatifrd pravmnel properh gather and esaluatr the infrmation ? <br />? <br />•, suhmilled. tiu.ed on my inquire if Ihr person or persom who manage the systrm. mac.}--•?- - --- <br />_ or thou Ix non, din, 11% resp.msible for gathering the Information, the information <br />- submitted is. to the Ixst of m> knowledge and belief, true. accurate, and rnmplrte. Cl A3 <br />T) ( <br />: C <br /> <br />I am aware that th <br />re <br />i <br />ifa <br />a <br />t <br />alu <br />f <br />h <br />itti <br />f <br />k <br />i <br />f <br />i SIGNATURE OF PRINCIPAL EXECUTIVE l.• ? <br />1 , <br /> <br />TYPED OR PRINTED e <br />are . <br />c <br />n <br />pen <br />e% <br />or sa <br />m <br />ng <br />nn <br />a <br />e <br />n <br />ormat <br />on, <br />including flit p.nsibility of fine and imprisonment for knowing siolations <br />I <br />OFFICER OR AUTHORIZED AGENT <br />' <br />AREA NUMBER <br />CODE <br />YEAR <br />MO <br />DAY <br />y <br />?.......... <br />m. auoa.nn.c..a.? nc. cr <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. ' I'his`IS 8 4-??Tk fOml.