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PERMITTEE NAME/ADDRESS tint W, Fa,,hn NameHocatwn dDiffrvvN! NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS i ; tF 1 ELL' MIN! <br />P PERMIT NUMBER DISCHARGE NUMBER <br />Ftl"i' MONITORING PERIOD <br />FACILITY <br />YEAR MO DAY YEAR MO DAY <br />LOCATION FROM TO <br />REi. <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. FREQUENCY SAMPLE <br />OF <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT is C1 -w IcL _ r> L <br />- ' c ;H -IJr3 VALID- REQUIREMENT - AF IFIUF; - _ r?arv"rl <br />_..I ._ 3I.F SAMPLE <br /> MEASUREMENT <br />i PERMIT #4#!t ii #T r:t t# sy## ; ;'EFORT WICE: -3RAL <br />El FL:,", 'r GRGEis REQUIREMENT F# _?ODA AV G .) ;:L.Y M.'k MONTH <br />- 1 i_ i .. YF U,-` i. SAMPLE <br /> MEASUREMENT <br /> PERMIT s =:f c x } # si - .. ; # # til ;r r; s- t t (j N GR. A! , <br />LUt REQUIREMENT <br />UR SAMPLE ; ' <br />Hit is i R L r' LAW MEASUREMENT <br />C.,50 PERMIT i ?T #:fi?z?i + ir+r9-0 i' q###;r# :t' ?FE+ <br />It f' - t: A[ Ur REQUIREMENT <br />i SAMPLE r 1 i r o <br />` <br />' 1 SUAL MEASUREMENT <br />. <br />. PERMIT ##-: z#x FJF;.CRT <br />t +VL-. <br />FLU _ REQUIREMENT i., <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />MEASUREMENT n <br />n I U <br /> PERMIT !1 V <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I cc-t> under penalty of law that this document and all ittachtnentc were TELEPHONE DATE <br />_ prepared under my direction or supervision to accordance with a system designed <br />1 L u <br />ro <br />erly <br />ather and evaluate the information <br />nnel <br />N <br />h <br />l <br />f <br />d <br />M <br />p <br />g <br />at qua <br />perso <br />p <br />to assum t <br />i <br />ie <br />U <br />I 1 <br />suhmnt A Bused on my mqutn of dtc peron or persons who manage the system. <br />the tnf i mmton <br />responiolc for eathcnng the information <br />m dtre <br />:tl <br />thos <br />et .- <br />/ - <br />?/ _ , <br />or <br />e p <br />so <br />s <br />y <br />i <br />f <br />l 1 <br />Is/ , ttvc. aceurme..utd comp <br />ete <br />e <br />submitted is. u+ the hest of ms kn neledge and bel <br />f <br />i SIGNATURE OF PRINCIPAL EXECUTIVE <br /> ormat <br />on. <br />I am aware that there are sicttificant Penalties for subnomrc i :',c in <br />f OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br />TYPED OR PRINTED or kr,.., „iauons <br />ncluding the possibility of fine and imprix nment CODE <br />COMMENTS AND EXPLANATION OF ANY VIOLA71UN5 (Hererence an arracnmenrs nere) <br />NT. "30BJEC7' TO EURDEN OF PROOF RFT_)1RrN!T-A!TR TP,I PAP- <br />il W I T-H I N HOUR <br />;,,` ; -.3 / s. 6 ?} arts ferm. <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. O I,; LQ PAGE OF