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PERMITTEE NAME/ADDRESS,hlrlade Fnrilm \umnZ rutioa it rliffr"111 <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION I C <br />t: D <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved <br />OMB No 2040-01 0-1 <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION N0. FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT r^ i <br /> PERMIT sl : tN i <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT a k*. F, <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />-• MEASUREMENT <br /> PERMIT <br /> REQUIREMENT ?: . <br /> SAMPLE t- <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT r • : , I. : i i <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER 1-t-fir-wit,rix-nalt-1I..Owl lhr.d,wumr-rn.rnd:rllulla.hmr..1-1 ra• <br />Mv <br />l <br />i <br />i <br />h <br />l ?. <br />J TELEPHONE DATE <br /> ?m•n.uprn raisin m.n r,?nLnur..il <br />a.,.Irm <br />?n,r <br />pngran+ <br />undrr m, d <br />rni /. <br />. ??.? <br />?? ? / <br />?- lu a..urc Ilu,l yualifad In-nrnuu•I probe rt, ;:rlhcr end ea alunlr Ihr mforn,en,m _ ? <br />? <br />. <br />I ? .nhnuneA. B:r.rd on m, mgwn ??I thr Iwnnn sir ponr?u, n ho m:uuy:r Urr y.tem. /? i <br />r <br /> or its-,Iw•r.rm, di-11% mlwm.ibir G•r <br />y;allrrnnr; the ndonnulnar. Ihr udurmalpm <br />te- . ? 111 ?.... <br />` <br />L? .n <br />hrnrmd i.. n. thr he.t a nq hno., led_r .,nd Ix lien. true.- -M,. and -nsplete <br />. <br />l <br />h <br />l <br />f <br />I <br />l <br />i <br />f <br />l <br />i <br />h <br />' EXECUTIVE <br /> <br />SIGNATURE OF PRINCIPAL <br />Ce, - - <br />+ <br />- / <br /> am u,..rtr t <br />nrt rhrrr a r.il <br />tuGunt Irruu <br />,? <br />ur .n <br />nuttmy <br />.r <br />oru,al <br />ar <br />. <br />r <br />l <br />a <br />n <br /> <br />OFFICER OR AUTHORIZED AGENT AREA <br />TYPED OR PRINTED u,hrdinc it.,, p,,..il•d 1. •.r rnr. nd wgv....nmrnt r r .n,l.ru...... CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />1 <br />EPA Form 3320.1 Rt•? 3 99; Previous editions may be used I hra a r a74-p tri limn. PAGE OF <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR)