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PERMITTEE NAME/ADDRESS tlurlude Factlin :YJm, <br />NAME <br />ADDRESS C Fr: is Ji,i ,IU: vC T I ON M <br />3 JACr,-'HIJ tD HT_ <br />`-1 I TA PALLS <br />FACILITY 730Iu JUNCTION 1•1 <br />LOCATION Y NG-0 <br />. ',r AM I'll 1;71r. R I" l-I T <br />.. ,.ifn.n tl Pi fe'.."o NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPOES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER F <br />_:?] <br />MONITORING PERIOD <br />I Pd ( YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved. <br />OMB No. 2040.0004 <br />EI'll POND TO '. CNYP <br />x <br />NOTE: Read Instructions before'co?hpleting this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE I MAXIMUM UNITS <br /> SAMPLE r <br /> MEASUREMENT <br /> PERMIT tr 39 Tit ' . "..- , <br />;- r- - I. - REQUIREMENT <br /> <br />'` <br />SAMPLE 7 7 <br />F flryf_ MEASUREMENT <br /> PERMIT t 1r : 1# 3l I <br />i ?? 5 <br />tiiRC`_,:=. REQUIREMENT <br /> SAMPLE 4. = <br /> E <br />T <br /> M <br />ASUREMEN - <br /> -? ,F, <br /> PERMIT ### i <br />LrL.+JcNT GP.:,: :' REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> IREM <br />E <br />NT -/ <br />DENT <3p S3 VAi_k.': R <br />QU <br />E <br /> SAMPLE ` <br />\ <br /> <br />P1. <br />"HRV TREATMENT <br />MEASUREMENT <br />?. <br />- <br />- PERMIT <br />t : REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />L PERMIT F Fu 0n r <br />_ 1_ U - NT+' .' i i • REQUIREMENT - <br />AND SAMPLE t> i 1: <br />I SUAL MEASUREMENT <br /> PERMIT --a ; H <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I Lenity under Nnalr of lac% that this document and all attachments were TELEPHONE DATE <br />prepared under my direction or suNrviston in accordance sorb a ;,. t m designed <br />Il ??'¦l ..-?. l'. ?? to assure that qualified personnel properly gather and crnluatc thr mt.,rmnuon <br />11 <br />A ._ <br />submitted. Based on my inquiry of the person or persons who manage the ..item, - ?-. <br />"' <br />t ur those potions directly responsible for gathering the information. the mforontinn - :t <br /> <br />r <br />f .t / r cubmtted is <br />true <br />accurate <br />and 011"pIcte <br />to the best of m} knowlctiga and belief <br />A . -?? T } ) I . J 7 r <br />It <br />. <br />, <br />, <br />, <br />. <br />, r <br />PL c <br />th <br />if <br />nt <br />enaltie <br />for s <br />hmmin <br />false information <br />I <br />t th <br />i SIGNATURE OF PRINCIPAL XECUTIVE <br />' <br />am aware <br />ere arc s <br />ica <br />p <br />u <br />g <br />a <br />gn <br />s <br />d i <br />m f <br />k <br />l <br />ti <br />d <br />d <br />h <br />it <br />lit <br />f f <br />i <br />TYPED OR PRINTED OFFICER OR AUTHORIZ AGENT AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br />y o <br />ine an <br />mpr omne <br />now <br />ng iso <br />ons. <br />n <br />u <br />mg t <br />e pos <br />t <br />or <br />a CODE <br />COMMLN I, ANU taXPLANAI IVN Ul- ANT VIULAI1UNa (rtererence alt arTacnments nerel <br />:ECEIP EVENT, SUBJECT TO PURDEN OF PROOF REQUIREMENTS IN <br />TO THE P I V I S I C)N WITHIN 48 I-InURS. <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. Tftty. is riftt1 form.