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PERMITTEE NAMEIADDRESS flnclude facilifv Namr1location if l)ifferenf? <br />NAME T !yG <br />ADDRESS <br />_) 7 <br />FACILITY <br />LOCATION v <br />... I C.,;".-e G:4 C';t•: chrf?TAltc?r <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION 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 L_ I <br />Form Approved <br />OMB No 2040-000-1 <br />Ilk ITT <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE I ?? J <br /> MEASUREMENT <br /> PERMIT a, o "41 <br />Y <br />) . <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 /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I ortip under penulti of I:.m that thi, document and all attachment% more - TELEPHONE DATE <br /> prepared under my dire, t,n or sup•r%ision in accordance with a gstem designed <br /> <br />4 to awwre that qualified r-mmecl properly gather and eaaluate the inrnrmalion <br />e tln• evstem <br />ed o <br />n <br />of th <br />erwn or <br />rer.on. who mana <br />itt <br />Ra <br />m <br />ir <br />b <br />d <br />_?- <br />- s <br />r <br />g <br />. <br />su <br />m <br />n <br />r i <br />qu <br />y <br />e p <br />e <br />. <br /> or thus- Ixrsom directl% responsible for gathering the information. the information <br /> <br />`•4 suhmiued is, h. uu• hest .d ma knowledge and belief, true, accurate, and complete. <br /> <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br /> I am aware (hut there ar •ignirteant penalties. for submitting fal, information' <br />risemment for knowing si.duiiuns. <br />the <br />ussibilit <br />d Fine and im <br />i <br />l <br />di <br />OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br />TYPED OR PRINTED y. <br />p <br />nc <br />u <br />ng <br />p OD <br />COMMENTS ANU tANLANAI IUIV Ur ArvT VIULA I IUI`1J IrfefefefltGe alt auacnlnrnts 11tffe1 <br />. P(: 4 FOR RE-4U? REME_P <br />EPA Form 3320-1 (Rev. 3199) Previous edi ions may be used. _ This'is a 4-part. form.