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PERdITTEE NAME ADDFiE?;S <br />NAME ?,..? _ .. . <br />ADDRESS -![ <br />FACILITY <br />LOCATION a` C- S S 12 2'6 <br />PAT Y.'? ElI?. 11TNF MGR <br />UISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER F(' <br />MONITORING PERIOD I: CR `Pig <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />NOTE: Read Instructions bef6 a co Ietinq this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT dt a; 4 x s 6. 5 a ;J 1 JFr <br /> REQUIREMENT NI I :'d 1 Mk)i? d `. <br /> SAMPLE s ., <br /> MEASUREMENT <br /> PERMIT .t -E _f? # _•;. .? .W 1 C F_ r ''F' AP <br /> REQUIREMENT hiUr•i fh; <br /> SAMPLE t ,' > <br /> MEASUREMENT <br /> PERMIT # = .i a;t a # # ?t 1. Pi I2 jr <br /> REQUIREMENT ! r <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT R EPOR T R'-!-,;-I a T <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT RI IrjPT T <br /> REQUIREMENT n} to Y <br /> SAMPLE <br />\ <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I ,endy under 1,enallN otlaw that this document and all attachments 1,e re <br />d TELEPHONE DATE <br /> <br /> <br />" ? ? ? `' <br />?? a, prepare <br />under my dur utm n(it n .open faun at n with a system designed <br />to ass <br />to ure that yuahficd peronncl pu,perly gather er and eva esninate the rntbnna[ti•?n <br /> <br />-71 <br />/ ? <br />S <br />-- sulmtitted. lias. d tin my myuuv of the person or persons who manage the .}:stem. ? ?• ? ?? ? ?, ; ; ?• <br />- or thus person din tlr reslainahle for gathenng the infurmanon, the mformatwo ? - <br /> <br />r <br />submtnrd is. I., the Fx?t of my knowledge and behet: true <br />accurate <br />and complete <br />f O J ? <br />7 <br /> , <br />. <br />I am awar <br />than th <br />r <br />re <br />ifi <br />a <br />t <br />dt <br />f <br />b <br />m <br />t <br />l <br />t <br />ti Sh? <br />JATURE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED OR PRINTED e <br />e <br />e a <br />stcn <br />pem <br />Ks <br />or su <br />rn <br />a <br />c <br />n <br />ng <br />sc m <br />orma <br />on. <br />including the pnsstbiht•; of fine and impnscmment for knowing %tol:mons OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br /> . CODE <br />UUMMr-NIJ ANU LAVLANAIIUrld Ur- ANT VIULAI IUIVJ (nererence art arracnmenrs nere) <br />r--NT S <br />U14JE,--T, TO E:;-4?1) rti? C:i- F..... - R, .u <br />•r7 c_ ;t - <br />c •. <br /> <br />EPA Form 3320-1 (Rev. 199) Previous editions may be used. {) S 13' is H ?$ft fom?. PAGE OF <br />