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PERMITTEE NAME/ADDRf ss.parrie_s.rdrpd..r ! eratw. t/n?r.a?)?-_ <br />r <br />NAME " <br /> <br />ADORESS <br /> <br /> :'= EKER C'r' J 1 b <br />FACILITY -OWY^ 'i I `iE <br /> <br />LOCATION Ef(EF? 'r: > t t 6 <br /> ELLY `!AIIN 1 RS, VP uT' QPS <br />NATIONAL POLLUTANT t)ISCHAFIGE ELIMINATION SyVtM (NPOES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER Of5[HMOE NUMBER <br />MONITORING PERIOD <br />Y A MO DAY YEAR MO' DAY <br />FROM TO <br />I <br />Form Approved <br />MINCER OMB No 2040.0004 ' <br />t StJ ?' FZ t ,:- ' <br />F - FI:SfiL <br />STREETER i=ZILCH TO U0IC'I <br />x NC DISCHARGE i? i X <br />NOTE: Road Inettrucdom befoco completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. <br /> <br />EX FREOUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ANALYSIS <br />:. .__ <br />- SAMPLE <br />MEASUREMENT 10 <br /> - - <br />J <br />F I_UENT ?iiL1'?•: ti_I.%t PERMIT <br />REQUIREMENT :301DA AV,' DAILY MY <br />-_?_- L r : <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />--- ? --- <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />-- - - - -- SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />-- SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER . certify antler Penalty . b+ that thh dorwt.wnt and aN attarhments wen TELEPHONE <br />- ? ?---r-- "---?_ <br />Pnp.red anaer mr dlrxuon or suPerHtion In aceordanre with . sTstem eeelgned .? ,/ _ <br />??/ t?- Io sewn that eitioHnod perw net Property gather and r.atuatt the Irormallon` <br />aobmitted. Ea eel oet me Inquln of the Pervert or Pemt who manage the system, <br />i or Ihose Perooro directly risparnlb4 for gatherlrK IM Informatloa, IM inrornrllnrt <br />t <br />Y ti eubmilted IS. to the bnt (my kaowkdge and better. true, amtrvte. and cotnpkte. <br />t then are <br />SIGNATURE OF PRINCWAL EXECU77VE <br />th <br />l <br />lfl <br />t <br />lti <br />f <br />b <br />dttt <br />F <br />y I DATE <br />TYPED OR PRINTED a <br />e <br />gn <br />caa <br />Pena <br />I am swan <br />es <br />or m <br />r <br />ng <br />a <br />nfonnauoo, <br />Iwsiteding the potelbltity of flaw and hnpriaonment For knowing .lotaUmes OFFICER OR AUTHORIZED AGENT <br /> <br />NUhWR <br />CAAFA ODE <br />1 <br /> <br />YEAR <br /> <br />MO <br /> <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Relerence0attachments here) <br />PkLCIP EVENT 78 CLAIMED. IF ALP.?`1 Af'F'ROV'=1.1 By Wt?(;fir <br />-i F. <br />EPA Form 3320-1 (Rev 3/99) Previous editions may be used -i t ?" 'This is a 4-pan fOftn. PAGE