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PERMITTEE NAME/ADDRESS (1-& . Fwdtry )Vm../Lxatton (/D(f wr) NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM /NPOES/ <br />NAME DISCHARGE MONITORING REPORT (DMRI <br />ADDRESS: <br />i J, lox PERMIT NUMBER DISCHARGE NUMBER <br />tN I A MONITORING PERIOD <br />FACILITY I c 1`40c t I tVE YEAR MO DAY YEAR MO DAY <br />LOCATION ?N i A cO B 1 FROM TO <br />1 I TAM A PPAP IP MTWP M <br />i:.prm Approved. <br />-OMB No 2040-0004 <br />MINOR <br />(SUBR MH) <br />F - FINAL DEI <br />SR; DEER TRL DT(' OR UNMD TR I B <br />NOTE: Reed krstnicdom b•fcro completing We form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREO <br />U <br />ENCY SAMPLE <br /> F <br />O <br /> EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT LEKLY <br />f• <br />t <br /> REQUIREMENT i r?rlX " <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT >f# I'> 17- _, ' <br /> REQUIREMENT AV` I)F1 i L `i N ( rtONTti <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT 4***** #a###Tt ; +v##{ REPORT F'tEf? R r L - <br /> REQUIREMENT SOD/A r.'. DAILY NY' MONTH <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT et ## iF sr ?t t! ### ><it tf#ar ?• ='Gr )C? E000 WE/ <br />N (? <br /> REQUIREMENT <br />Ak) <br />iL !1Y <br />l <br />iCINTH <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ,? # ## tt a 1 f <br /> REQUIREMENT <br /> <br /> SAMPLE <br />l T P I. MEASUREMENT <br /> PERMIT REPORT c ( ; . <br /> REQUIREMENT lr,Zl_Y i`iK <br />r1I: SAMPLE <br /> MEASUREMENT <br /> <br />PERMIT : - T s-., x..## -777 7Z <br />REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER t crmly wml? Pariah y 0 .- that this document and all flachmerib .en <br />TELEPHONE <br />DATE <br />prepared Wndtr my dlrrct{on a super+tsllon In .ccordann with . system destgnd <br />to avurv that g..Bnd pereonnel ie-prr{y g.IMr end ...Walt the Info llpn <br />ftlhmined. Bawd on my IrpWlry or the peter a prra wh. mMagr the fntrm, <br />or those persem dimity -PeMbk for g.thMng Ut Inrorm.tlon. the Inform.tbn <br />mbmltted Is, to the best of me Itmawldge and belkf, trae, accurate, and t Purl.. <br />I am a..n that then .re.lpdnranl penance for sabnrlatn f.tw Infornrnon, SIONATURE OF PRINCIPAL EXECUTIVE ' <br />TYPED OR PRINTED Inciudlnt the povlblBty of not and Imprtammenl for knowing .Iolatlorn OFFICER OR AUTHORIZED AOEF(T CODE NUMBER YEAR MO DAY <br />(.VMMCPI I J AnV CArtsnn Inwrwrwncw wr wnwcnnr wnta rrlrwr <br />r.rrFl F, rI a?r~r*? Tr r - pc,-R(-,-/t-71 EPA Form 3320-1 (Rev 3/99) Previous editions may tie used TIUS IS a 4-Part Corm. PAGE OF