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PERMITTEE NAME/ADDRESS huInd, I nr,im \mm,'l.,,urn.nr a baftrena <br />NAME <br />ADDRESS - <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 Nc. 204 0-0004 <br />F- I MAL_ DEL A <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> EX OF TYPE <br /> YSIS <br />ANAL <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE s a <br /> MEASUREMENT <br /> PERMIT +; n a fi r = i s „ `? _ - r <br /> REQUIREMENT <br /> SAMPLE <br /> ? <br />/ <br /> MEASUREMENT l <br />i, <br />6; <br /> PERMIT tP :d ,I y i #-a-a ti # # a s r ', '. r iF(raLt <br />I REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT #.? tt x :C'-F(7L; T <br /> REQUIREMENT <br />A <br /> <br /> SAMPLE 4 r 'a :- -= r <br /> MEASUREMENT <br /> PERMIT s a rr ,?r it r r# i:' <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />t.- t_- 1, REQUIREMENT <br /> SAMPLE ,. <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT r, <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I en 7. nmh r rw'-I" .d law that th„ hl un.cnl and ull auarhnr.•nt, ..ore TELEPHONE DATE <br /> p-1 1 under m, di-i-n or ,nlw n i.vm m - ord-. -th <br />r -I.- d,-gnr•d / <br /> <br />(?i?! 11 r-1 ),r /Ac fl r" , . <br />Ina......lhal.p.AIr"'II--l-IIrr„I,e,I, Lather amI e.'A-w the.nfnrn.a w" / . / <br />/ <br />?/ <br />/ ? <br /> vrhmiurd. ItuK•d .... nq .... ...I th. q r.un ..r la nnn, whn munu>;r thr. ,.,ten,, _ <br />/" <br /> ur I)..- Iw n.m, dma. n.l,.ar„Ide f.n l;athenn_ 16r Iufnnuatrnn. Ihr informal i.a. e•? <br />i j J `'? „ ubmutvd i,. I" the hr.r .d m, kn,:..l.Ag. mid Indml. 1rne. rcour.le. .and...mplot . <br /> <br />1 am a,.ar. Thal llo re an• .i?mfic:nl <br />n nulb.? h:r -1-maw hd,e rnr:.rm <br />i,m SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED OR PRINTED I <br />. <br />. <br />lwlmliuy; the I" ,'Inlih •d rinr and nupri onmrnl 1•.r Ln,.n m riolulion,. <br />OFFICER OR AUTHORIZED AGENT AREA <br />CODE NUMBER <br />YEAR <br />MO <br />DAY <br />GUMMtN I, ANU tAYLANAI IUN VI- ANY VIVLAI IVNJ 11•rererence an anacnmenrs nerel <br />_CIP EVENT SUTE-JECT TO BURDEN OF PF2^C)1= REQUIREMENTS IN <br />:I- ?7 T'r+. 7IV? iUi•I WITHIN 4:3 HQIJR <br />EPA Form 3320-1 (Rev 3r9g) Preaous editions may be used. OQ i-•O a. This-lk SY 4-part,IwQmi.