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PERMITTEE NAME!ADDRESS ibxladc Fad(in :?'umr.'L.:rurron ii(Affewnt, NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />JV f PC, 'r" . 7 1' ; <br />ADDRESS !iv _ vIVCT I GN h? I I'iI <br />'.• , Aii?SiiOF?il i i I' ?`. ' PERMIT NUMBER DISCHARGE NUMBER <br />FACILITY H I TA FALLS MONITORING PERIOD <br />3 ul`; JUNC T I Oiy M ; YEAR MO DAY YEAR MO DAY <br />LOCATION : j,9ANC0 FROM :. t TO <br />qRyr?P1 r7OFF. <br />Form Approved. <br />OMB No. 2040-0004 <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 /> MEASUREMENT <br /> PERMIT it t si r r a f _ _ ?_ <br />E' V._ ?ROS"S VFtiI REQUIREMENT rr <br /> SAMPLE j <br />E MEASUREMENT <br /> PERMIT } R A U <br />1).I-4r V \Lt REQUIREMENT -:I <br />ME _ SAMPLE <br />i <br /> MEASUREMENT <br />?,. PERMIT 'OKT E/ `H6D <br />F,i OF=.r,i' REQUIREMENT <br />T ' SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />l O`_;`-1 ;v,AI REQUIREMENT <br />IJd 7.iLl I T SAMPLE <br />HRU TREA1-MENT PL,''•1•. MEASUREMENT v? v'\ <br />-.'?c , 1 F) r? <br />- PERMIT 'rF'-. F?" " T <br />P i + st##### # # 1#?? 't7NTIll <br />r <br />'11811, <br />HIDF Vt^' c REQUIREMENT :,Y / 1.?CUB. <br />J, SAMPLE t <br /> MEASUREMENT <br /> PERMIT REPORT REPORT =RAE <br /> REQUIREMENT <br />-r SAMPLE <br /> MEASUREMENT i <br /> PERMIT :i.:A <br />i REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I cer,iy under penaln of law char this doaunent and .ell arcthment< were <br /> <br />ti <br />d <br />d <br />di <br />i <br />i <br />a <br />h <br />d <br />i <br />d <br />TELEPHONE <br />DATE <br />I t <br />Fs• Y- tr ?' V7+v V • er my <br />prepare <br />un <br />rec <br />on or superv <br />.um <br />n accord <br />nce wit <br />a swem <br />e <br />gne <br />to assure that yualiiicd "onnel properly gather and c%dunte the :nformet:an , <br />,\ <br />„?1 V (•''? - •? C r P?. r'. /?,? _ submitted Raced an my inquiry of the pem)n or pe-ris whu manage the .}'Stem. <br />or those persons duecaly responsible for gathering the inhumation, the mt,,mution <br />!r7 <br /> <br />subrmttad is. to the beet of my knowledge and hehei, true. aecuratc. and- nplete. <br />enaluc, for :uhmming false infom+: !:an <br />I :vu <br />,u:ue that there are significant <br />S A RE OF PRINCIPA EXECUTIVE ,/ ,// <br /> <br />TYPED OR PRINTED . <br />p <br />' <br />iudu. rile <br />.ssibdity of fine and nn <br />ri-nincn: ,;,, ln <br />.wun <br />siolatn' <br />' OFFICER OR AUTHORIZ D AGENT AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br /> p <br />. <br />mc <br />p <br />. <br />e <br />n CODE <br />GUMMtN l b ANU tRrLANAI IUN Ut ANT VIULAI IUND (Kererence all anacnments here) <br />'RECE IP <br />_ . i -D T;' TF- <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. <br />- i s•i6p 4-part' f?nn- <br />_ .. _ . <br />TA