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PERMITTEE NAMElAODRESS /7wrifr F.r ihy N.w?Lxulow IJDIQIwwerJ NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDESJ <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS ' <br />1 i A I .•` PERMIT NUMBER DISCHARGE NUMBER <br />FACILITY 'ljvjyJ (t; ;'•ii. MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />LOCATION FROM TO <br />LLlr' D. SANrIFR=.. va c-11= npc? <br />Form Approved <br />OMB No 20404004 <br />NOTE: Read Iratructiom betorts rmmnlisNnn this Enrm. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> OF <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT t =t y l v , <br /> REQUIREMENT I ti : `•S , ', "A X I t'iUM iyCINTF <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />:•k.:!:: _. '.;, REQUIREMENT DAI _ y [,I'- <br /> SAMPLE - <br /> MEASUREMENT <br />_ PERMIT <br /> REQUIREMENT :]C-tLlA AVID !)t•1IL-Y !1111 MONTf <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />L?'E?Ft '•'?'.: REQUIREMENT -301) A AVt !)F-ILY 1'IX i'- MONTH <br />C : SAMPLE -.-- - <br /> MEASUREMENT <br /> PERMIT .K ?? .. y , s PC t, <br /> REQUIREMENT !°IAX <br />.1'•! 1;i' .t SAMPLE ..".: <br />' J TREA rl-,E T P E. - • MEASUREMENT <br />L"? ; :1 it PERMIT <br />=. ' REQUIREMENT :?i. ! "- i)r ##3I # P'1C11`J71 <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I n^Ily under pen' t, ° isw that Ihh dorstment and all attachments were J? <br />TELEPHONE <br />DAT <br /> prepared ender my dlrettbn or super.tsion In ism. a- with a y.fern dd9r" E <br />i T <br />/ anwrt that qu stilted Perwnnet Properly Lal her and eralua le the Information <br />' <br />^ <br />-- submitted. Based on m7 Inquiry o! lM Penon m persons who manage the /ystem, ?'• / <br />?/7 <br /> <br />• or Ihmw persons dlnelle responsibig for gathering the Inform.llen, the Infor,nallon (' <br />1 C) <br />' n L <br />''- submitted Is. to the besl of my knowledge and b.110. true, etc rate. and tompkle. ( <br />7 <br />r I am swam that there an significant Penalties for submitting false Inrorntatlon. SIGNATURE OF MIINCNAL EXECUTIVE <br />TYPED OR PRINTED Including the possibility of line and Imprisonment for knowing siolauorm OFFICER OR AUTHORIZED AGENT <br />AREA <br />OOS NUM[lER <br />C <br /> <br />YEAR MO <br /> <br />DAY <br />I.VmMCfl 1 J AMU Cnrln-n r rvr? v. ?•? • .•v..n • .vre.? Inver wr wrr a.w am err rarcrrr rrwr/rJ rr err w/ <br />'4I•-IR Pocr-TP EVENT •_r Ct A. IMEr) TF CL.ATr. APPROVED ! -' WDC.D <br />EN F?J 71" <br />EPA Form 3320-1 (Rev 399) Previous editions may be used aj S- A_ PAGE