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PERMITTEE NAMUADDRESS (1adrLiaNhryXaee?Loraaaw ?n10G?V NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM j(NPDESJ Form Approved <br />NAME DISCHARGE MONITORING REPORT IDMRJ OMB No 2040-0004 <br />ADDRESS <br />) I` <br />' <br />?' <br />I] <br />n: <br />;. <br />L ?i! 1 <br />7? 1 :i AT? <br />i +Z IJ! 1 PERMIT NUMBER DISCHARGE NUM8Fw <br />_ <br />;J FINA_ i _ ? <br />MF <br />FACILITY <br />MONITORING PERIOD <br />h <br />' YEAR MO DAY YEAR MO DAY <br />7 ,_D //finFi` F?. <br />71 <br />LOCATION <br />. . :? . , - FROM TO <br /> <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FAErJ <br />UFNCY SAMPLE <br /> O <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE <br /> <br />I SAMPLE <br /> MEASUREMENT rir I <br /> PERMIT <br /> <br />t c 1 - <br />- c r <br />. <br />REQUIREMENT -x$ <br />,f. A <br />... fi q 0 r F. <br />_ <br />r .cam P •I+ t Iv, t'- _'J <br />"- <br />"- <br />-, SAMPLE <br />, ,- .. <br /> MEASUREMENT <br /> <br /> <br />5 C PERMIT <br />`!O <br />r.; ?A#? <br /> REQUIREMENT <br /> <br /> <br />j <br />' T SET-r t_,- <br />?L. s U5, SAMPLE <br /> MEASUREMENT <br />`•. G PERMIT si##ti#? is. r.?r 9Ci?J{4r RFC; Rti lP1S??-? _?i7 <br /> REQUIREMENT <br />r f?l c t• f M01.4 <br />1 SAMPLE _ .:. <br />... <br />- MEASUREMENT <br />AL qc?- fl f` <br />n •.:: <br /> PERMIT <br />Q <br />C- F= ART <br /> REQUIREMENT <br />f <br /> SAMPLE <br />?. <br /> MEASUREMENT <br /> PERMIT <br />44, <br /> <br />`a <br /> REQUIREMENT <br />_ r UST <br /> SAMPLE <br /> MEASUREMENT <br />r r __ rt T <br />. , ; <br />^ . <br /> I <br />_ J <br />1 <br />0 PERM <br />T <br /> REQUIREMENT <br /> <br /> SAMPLE -- <br /> MEASUREMENT <br /> PE <br />MIT --- - <br /> R <br /> REQUIREMENT <br />NAMEMnE PRINCIPAL EXECUTIVE OFFICER t Ce"rtf " ana ly o aw that th <br />under me dtrecrton or fu <br />prepared pe h document ¦nd all alf-hm <br /> <br />nMon to accordance with • enE, wen <br /> <br />errtem d <br />ned --? <br />TELEPHONE <br />DATE <br /> ar <br />t <br />h <br /> o a sure t <br />at auaenedarsonnd P Ae gather and -aluUr the Infnrnytbn <br />anbmttted ea <br />ed <br />m <br />in <br />l <br />f 1M <br />-? <br />/+ <br />? s <br />on <br />f <br />Qu <br />rr o <br />person or persona ?ho man ate the mtrm. _ f <br />?? <br />I <br /> <br /> <br />! nr those pro dlrerth mponatbie Im Eatherlnig the Information, the <br />Inlarmatloa <br /> <br />wb <br />ltt <br />f <br />d M <br />t <br />?'C? <br />-??7` '? ? -- / <br />- - <br />::?' -r, c-'?Y <br /> <br />•'7 <br />_ <br /> <br />i <br />f m <br />e <br />. b the bat o <br />mf <br />ne.ledge and belief. Irve, accu ntr. and compote. <br />t am.- that there ¦" d)tnlnrant penalties for eabmittl. <br />fate, Inf <br />r <br />ll <br />SIGNATURE OF PRINCIPA <br />X <br /> <br />TYPED OR PRINTED S <br />o <br />ma <br />c t, <br />InrIudtnt the powSDllltr of floe and Imprimament for \no.tnE .lolauorn L E <br />ECUTIVE <br />OFFICER OR AUTHORIZED AGENT <br />NUMBER <br />C <br />YEAR <br />MO <br />DAY <br /> ODE <br />. T) 71 T"I•. I. _. 3 •n t_ L"t:i rit, f. r• r, <br />t t; . <br /> <br />EPA Form 3320-1 (Rev 3199) Previous editions may be used this Ida 4-pari form. PAGE OF