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PERMITTEE NAME/ADDRESS tlnclude FaciGtr lamr/Grcation if UiJJrreu? <br />NAME f?f I N <br />ADDRESS <br />";IF 210 <br />FACILITY <br />LOCATION <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 2040-0004 <br />DUTl <br />NOTE: Read Instructions before completing this form. <br /> <br />PARAMETER <br />QUANTITY OR LOADING <br />QUALITY OR CONCENTRATION No. <br />FREQUENCY <br />OF <br />SAMPLE <br /> EX <br />EX SIS <br />N <br />L TYPE <br /> A <br />A <br />Y <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE -, - <br />I _ - ', <br />? T..l <br />It1 <br /> MEASUREMENT <br /> PERMIT .. ?: : , .. - . <br /> "iA X I Mt_;;) : IC i •: <br /> REQUIREMENT <br /> SAMPLE _? /: a (I -a 8 <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT J riV <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT t • ; <br /> REQUIREMENT <br /> SAMPLE j tP <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> <br /> SAMPLE f <br />. (? ' ! / " P It <br /> MEASUREMENT _ J v <br /> <br />PERMIT rl.rr 7r .7 <br /> REQUIREMENT is ?' f?C1fVT! t <br /> SAMPLE r,'/A <br /> MEASUREMENT <br /> <br />PERMIT <br />•, 1 <br />a 17 r <br /> <br /> REQUIREMENT <br /> SAMPLE ' 1 , 1 f l lam) '.j?,.1 <br /> MEASUREMENT bC <br />PERMIT <br />REOUIREMENT <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER I certif% under penalty of Lo, that this document and all attach. L. wen• I TELEPHONE <br />ith <br />d <br />i <br />ed <br />d <br />t DATE <br />.,,s <br />em <br />gn <br />anre w <br />es <br />Prepared under mi dirw or wlx•n icion in accnr <br />-_ + to unsure that qualified p, -,nnd prolwrl% gather and ccaiuah• the information <br />--- -ate <br />t'i ? <br />` <br />- <br />. submitted. Hnse,! on nq in%pnr. of the person or persons who managr Ihr aystrm, z ?--'_ <br />. <br />7 <br />or thow• 1wr,ans directly -1-isible fur gathering the information. the inh,rnmtion "? <br />submitted is. to the best M ,m kmnrledge and belier, true, accurate, and complete. <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />r <br />`"' d'„? <br />j?N? • ` <br />-•l? I am aware that there an significant penalties for submitting false information. ENT <br />TH <br />A AREA <br /> ris,atment rnr k-voing sh,lutions <br />and im <br />th <br />ibilit <br />' fin <br />l <br />di OFFICER OR AU <br />ORIZED <br />G NUMBER YEAR MO DAY <br />TYPED OR PRINTED . <br />e <br />p <br />e pns <br />,. <br />inc <br />u <br />ng <br />COMMENTS AND EXPLANATION OF ANY VIULHIIUIYJ (neterarlce c111 noel nrncnw ncr c/ <br />4 <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. <br />1. A. 2, PG. 4 FOR REf3L) I , EMENTE <br />?OOB' This is a 4-parl ftuni.