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PERMITTEE NAME/ADDRESS ilachide facilin 4mnrlLmw,m d hdh.n i <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />% i Fn uT: - -),Tr:t• .R,, - •ri: ,Y - TE ( NPDES? <br />DISCHARGE MONITORING REPORT 1DMR1 <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />FROM YEAR MO DAY TO YEAR MO DAY <br />Form Approved. <br />OMB No 2040-0004 <br />°4i_)TT <br />NOTE: Read Instructions before completing 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 />7 I'Cfl <br />?? ?f <br />l= <br /> MEASUREMENT <br /> PERMIT -. .. t ;' = . <br /> REQUIREMENT ; s JG ";' 1PI 1 '+'. <br /> SAMPLE <br />MEAS <br />REMENT <br /> U <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />MEAS <br />REMENT <br /> U <br /> PERMIT ` <br /> REQUIREMENT <br /> SAMPLE /?r l <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />7 ' "? <br />-= tear <br /> MEASUREMENT <br /> PERMIT t. ... .. - _ r• • -.__ <br /> REQUIREMENT spa! ;r <br /> SAMPLE <br />MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />REMENT <br />S Iva <br /> MEA <br />U <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I tertif% under lwnalty or law that thi, damment and all atlarhmenl were <br />nicio <br />with u <br />re <br />a <br />ed under m <br />ii <br />n <br />r <br />u <br />w <br />i <br />acc <br />da <br />wtr <br />cl +i <br />ed <br />di <br />1 - TELEPHONE DATE <br /> p <br />p <br />r <br />? <br />o <br />o <br />w <br />l <br />r <br />n <br />n <br />or <br />nce <br />y <br />m <br />nr <br />mn <br />to awwun• that yuuliried pt•rwonnel pr perle gather and esaluute the information _ -- <br />. suhmitted. Hawed on my inquin of the person or pv-n who manage the wy tem• --- 'iC <br />?j_ <br /> or three lxr.oa, direr •th m,ro-lMe for gathering the information. the information • -• <br />• <br />' _ <br />?' <br /> wuhmitied 6 <br />to Ihr hest of m± knowledge and W, ter <br />true <br />accurate, and c,anplete. - . <br />1 <br />, <br />, i <br /> , <br />. <br />, <br />w <br />lties fo <br />falwe i <br />lo <br />I am <br />r <br />Th <br />t th <br />• <br />i <br />ific <br />nt <br />e <br />uh <br />iui <br />tG SIGNATURE OF PRINCIPAL EXECUTIVE , <br />, <br /> <br />TYPED OR PRINTED a <br />a <br />rn <br />gn <br />a <br />p <br />na <br />r w <br />m <br />ng <br />n <br />rma <br />.n, <br />a <br />e <br />arc w <br />including the larwwihility or fine and impriwnment for knowing rioladons, <br />OFFICER OR AUTHORIZED AGENT AREA <br />CODE NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />EPA Form 3320.1 (Rev. 3199) Previous editions may be used _`t%?'• This is a 4-part fir!rm.