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PERMITTEE NAME+ADDRESS r/n hedc Facility Vamr-Uxanvn iJDiifiewml <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (OMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />WOTF• Raarl Inatrllrtinne hwfnro <br />Form Approyea. . „ <br />OMB No. 2040-0004 <br />thic Ifarm <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> OF <br />TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ANALYSIS <br /> SAMPLE <br />MEASUREMENT _ <br />(, f <br />' ??? <br />G b <br /> PERMIT # .µ # : s t= C7 c: t iii; '3 i7 CE,' V <br /> REQUIREMENT _ <br /> SAMPLE <br />MEASUREMENT <br /> <br />_ <br /> <br />k7 <br /> PERMIT r ;: ...•. <br /> REQUIREMENT f <br />J`JL4'1 Avl-. <br />iJl- <br /> SAMPLE <br />ME <br />! + <br />'? <br />I <br />'? J / <br />J <br />? <br /> ASUREMENT . . I - L b <br /> PERMIT r <br /> REQUIREMENT <br /> SAMPLE <br />MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT ; <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT i 'j <br /> REQUIREMENT r' i <br /> SAMPLE `I ` <br />O ? 'I <br />- -.. <br /> <br />MEASUREMENT U V ' VV P L? <br /> PERMIT i I!v <br /> REQUIREMENT _ <br /> <br />i SAMPLE <br />MEASUREMENT - <br />O <br />`j v <br />U <br /> PERMIT a S.. z r?EPORT r- <br /> REQUIREMENT ."")DA A ? <br />NAME.?ITLE PRINCIPAL EXECUTIVE OFFICER I ccnii' under penalty of Iaa that dn. docdrTtent acid dll uua@unenL were I TELEPHONE DATE <br /> <br />Dennis Jones prepared under rm litectwu or ;upennlou in accordance with a system designed <br />to assure that qualified pcr onnel properly gather and valuate the information <br /> <br />? <br />+1 submitted. Based on m <br />)' itWuury of the Fr -non or pc' rwn, who minaKc the system. <br />i' , <br />\ <br /> <br />H rolo Ifit : <br />or those persons directly responstble ILr gathering the information, the information T , <br />_ <br />- <br /> <br />itt <br />h <br />wl <br />d h <br />b <br />d <br />w th <br />t <br />f <br />k <br />d <br />h <br />t <br />t <br />d <br />l <br />/ 1 <br />276-5209 , true. accura <br />u <br />m <br />e <br />Is <br />e <br />es <br />o <br />my <br />no <br />e <br />ge an <br />c <br />c <br />e, an <br />comp <br />ete <br />t . th <br />m <br />th <br />lt <br />tti <br />f <br />l <br />e <br />f <br />ti <br />1 <br />if <br />t <br />fo <br />b SIGNATURE OF PRIN PAL EXECUTIVE <br /> <br />TYPED OR PRINTED aware <br />ere are sign <br />ican <br />pena <br />ies <br />a <br />in <br />orma <br />a <br />a <br />r su <br />mt <br />ng <br />s <br />on, <br />includ ng the possibility m fine and imprisonment for kmns,ni violations. <br />OFFICER OR AUT RIZED AGENT <br />AREA <br />NUMBER <br /> <br />YEAR <br /> <br />MO <br /> <br />DAY <br /> 0DE <br />c <br />UUMMC11110AIYU CAr LANAIIUPI Ur AtvT VIULAIiuNz Irre/erence all auacnments neref <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used <br />! tot t- ? Lk.. ?ti <br />This is a. 4-par-; t?nn. PAGE