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PERMITTEE NAMEiADDRESS •1,, ::,dc f i,cilirv.Y,me Z.xunon ij pi?rrrnu <br />NAME <br />ADDRESS LCJAT)CU <br />=+T SPR INGF) CO <br />FACILITY (> t Jf _CH C-t. <br />LOCATION I?a:N G <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER OISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR YEAR MO DAY <br />FROM MO DAY TO <br /> <br />NOTE: Read Instructions before completinq this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREOUENCY <br />OF SAMPLE <br /> ? TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />J MEASUREMENT <br />;w?lc PERMIT -.. ,. REPUR1 i 'i..l *##a i. t 1 i :w # R =r jr% Jrc t <br />i F I.- RC iS REQUIREMENT SNST MAX <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME:TITLE PRINCIPAL EXECUTIVE OFFICER l certd} under penalty ,d law that this document and all attachments wera TELEPHONE DATE <br /> pvctnred under to - dir ction or sup en•i+iun in accordance w-nth a system designed <br /> t„ asswv that guahlicd personnel properly "then and evaluate the information <br /> submitted. Rased on my inquiry of the per on or person, who manage the syucm. <br /> or those persons directly rraponsvble for gathering the mfomtnuon. the information <br /> and complete. <br />submuncd is <br />n. the best r,f my knowledge and belief <br />true <br />accurate l <br /> , <br />. <br />. <br />, <br />that ther <br />arc t <br />ltie <br />for submittin <br />false mformation <br />m <br />war <br />mficant <br />en <br />I SIGNAT E OF PRINCIPAL EXECUTIVE <br /> <br />TYPED OR PRINTED g <br />p <br />e <br />e <br />a <br />s <br />g <br />. <br />a <br />a <br />mcludm¢ the pt)sstbtlny of tint anti unpns, nment for knowing stolations. OFFI R OR AUTHORIZED AGENT AREA <br />CODE NUMBER <br />YEAR <br />MO <br />DAY <br />GUMMtN I' ANU tXYLANAI IUN OF ANT VIULJ41IUNa (Kererence an anacnments nere/ <br />I <br />PREC IP EVENT ac it <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. '.10248 " T his is a 4-part, form.