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<br />PERMITTEE NAME/ADDRESS rh:. r,.dr :'r- <br /> <br />NAME NATIONAL POLLUTANT DISCHARGE ELIm'.ATIOri S,'srEM (NPDES ) <br /> r?Y EC <br />C <br />V DISCHARGE MONITORING REPORT (DMR) 1B No. 2u.u-LUU4 <br />ADDRESS ?.,,? <br />? ?y?? <br />? ?f <br /> 'J <br />NOS PERMIT NUMBER Ep,HARGE NUMBER <br /> n T <br />`)CI 2 l <br />FACILITY MONITORING PERIOD <br />LOCATION YEAR MO DAY YEAR MO DAY <br /> I?jitling : p?b1W TO j, <br /> NOTE: Read Instructions before comniptino this fnrm <br />PARAMETER QUAN TITY OR LOADING QUALITY OR CONC ENTRATION NO. FREQUENCY SAMPLE <br /> OF <br /> EX TYPE <br />AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ANALYSIS <br />SAMPLE <br />MEASUREMENT <br />PERMIT <br /> <br />REQUIREMENT <br /> <br />SAMPLE <br />MEASUREMENT <br /> PERMIT <br /> F <br /> QUIREMENT <br /> <br /> SAMPLE <br />( <br /> MEASUREMENT <br /> PERMIT <br /> <br /> REQUIREMENT <br /> SAMPLE <br />_ MEASUREMENT <br /> PERMIT <br /> <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />" <br />F`L-: REQUIREMENT <br /> 1 <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - <br /> i <br />- -- REQUIREMENT <br /> i ,sett <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> <br />[ <br />R occ ;;, ., ) t,l <br /> EQUIREMENT - <br />NAME/'TITLE PRINCIPAL EXECUTIVE OFFICER I certify under penalty of law that this document and all atl.Khmenn Herr <br /> <br />prepared under my direction or supen'?.ion in accordance with a sv.tcm de,mgned <br />- -- - - - - <br />- - TELEPHONE DATE <br />- :,, alsute that qualified personnel properly father and cl'alualc the Informal.441 ? - <br /> -bmmed. Ba,%Ld on m\' mqurn' of the per on or pLr on, who nonage the S%,tem. _ <br />r _ <br />? <br /> or those persons dtrt:cth responsible for _pthering the mtormatmon, the informatio <br />b n - ? <br /> su <br />m tied i., to the h t of m} km w9 J@c anJ bnc?f. true, acctmalc, ;md complete. SIGNATURE <br /> <br /> <br />TYPED OR PRINTED <br />I .mm alr.ue that the r :ignmft , -. r t r inniming tahr information. <br />l <br />d <br />ill, <br />fi <br />- OF PRINCIPAL EXECUTIVE <br /> <br /> <br />OFF <br />C <br /> ,,,,. t <br />n; <br />mro <br />u <br />ne, <br />ne . ?n-mg 1'iolatton, I <br />ER OR AUTHORIZED AGENT AREA NUMBER <br />CO YEAR MO <br /> <br />COMMENTS AND EXPLANATION OF ANY VIOL <br />ATIONS (Reference all allachments here) <br />DE DAY <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. ?c; This is a 4-part >onn.