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PERMIITEE NAMEIADDRESS (include Facility Namell,ocatiun if ItiJfnrnt) <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />... ... , .- ?.. ..r? nor r_nl:. <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 <br />Form Approved <br />OMB No 2040 ! +xl <br />l U'r 1 <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, <br /> <br />EX FREQUENCY <br />OF <br />Y <br />IS SAMPLE <br /> <br />TYPE <br /> ANAL <br />S <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />MEASUREMENT i - <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />L <br />t <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT di 4 :, avla <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT( <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br />PERMIT <br />REQUIREMENT <br />NAMEfnTLE PRINCIPAL EXECUTIVE OFFICER I rrrul') under penal,. ,f law th:u On, document and all attachments were TELEPHONE <br />prepared under n,-, dirt, non- upon ision in accordance with a ydrtn designed I <br />_ Iassure that qualified rwmnrl mrlt gather and esid ale the inrormatlat <br />submitted. Rased on - Inyuin of the person or person, who manage the %utem, -- -? ???'?----' <br />or tho- w-ns dir-11% rt. pnsibir for gathering the information, the information <br />submitted is, to the twit of m% knowledge and belief. trur. accurate, and cum{dtte. SIGNATURE OF PRINCIPAL EXECUTIVE J ?• L( ?• DATE <br /> <br /> <br /> <br /> <br />?? s ! ?" <br /> I um aware that there arc eigniftent {woultie, for <uhroitiing false information. <br />ED AREA <br />TYPED OR PRINTED including the {eoessibilits 4 fine and imprisonment for knowing .iodations. <br />I AGENT <br />OFFICER OR AUTHORIZ E NUMBER <br />COD YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLA] IQN5 (Hererence all arracnmenrs nerel <br />`-`:`t-`\ - SEE I A 2, P-G' 4 FOR REGUIREMENTS. <br />EPA Form 3320-1 1Rev 399) Previous edition n:aq Lt- 7his {fi'a 4-{part It,i w