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!TEE NAME/ADDRESS (Include Facility Name/Location if Different) <br />,t E <br />Ri ADDRESS <br />FACILITY <br />LOCATION , °..1. "... <br />DES) <br />NATIONAL POLLUTANT <br />DISCHARGED MONITORING REPORT (D& R) <br />PERMIT NUMBER ?DISCHARGENUMBER <br />MONITORING PERIOD <br />YEAR MO- DAY YEAR MO DAY: <br />FROM TO <br />Form Approved. rl <br />OMB No. 2040-0004 <br />% <br />NOTE. Read Instructions before completing this form. <br /> - NO FREQUENCY SAMPLE <br /> QUANTITY OR LOADING . <br />QUALITY OR CONCENTRATION <br />EX OF <br />TYPE <br /> PARAMETER ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE " <br /> MEASUREMENT <br /> + a PERMIT a <br /> tLl 14 s; tr ,..+' REQUIREMENT <br />.. <br /> . , -,:. :.• .. <br /> ' n. ; `...__ <br />SAMPLE // J <br /> t r ?m ..:! dr. i MEASUREMENT ` <br /> - ° <br />' <br /> <br />v. <br />W° PERMIT ?^. <br />• _ <br />f <br />i <br /> .t AL .?" REQUIREMENT' <br />.. <br />a <br />: e F; :......, i <br />1 <br /> ,... <br />;. r:. .... `_! } • ...;..' ..L SAMPLE ^ - <br /> MEASUREMENT ?` <br /> _. <br />PERMIT <br /> 74 f_tr 3 °v.?s,. REQUIREMENT' ..r _. ? <br /> ?. 5 <br />. <br /> SAMPLE <br />^ <br />1 <br />' <br /> at_c MEASUREMENT <br />E,i <br />MTAL 77i`v <br />.. ... r ??,* <br />t <br />? I <br />'E <br /> 1 <br />`tt # c <br />PERMIT .. <br />l t t :. <br /> VAL_U'r REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />7-77 <br /> Es i ` PERMIT j i_n „ <br /> Y-:.y,• <br />U d a Gli(. SS t'A ,4- REQUIREMENT <br />i ° w. <br />•x <br /> . n <br /> -. SAMPLE <br /> <br />T "HR.', tp MEASUREMENT _ <br /> - to -1 t t F) PERMIT <br /> <br /> <br />'?• C?laS ... REQUIREMENT <br />'N 1 R <br />F i I <br />f <br />U <br />E <br />" <br /> : <br />.. <br />... <br />- <br />7 7, 7 -7 <br /> SAMPLE .• .. ,. _. <br /> "1 ?. "'CII. t 1 MEASUREMENT W.. a . , . v . . <br /> :`> ry ? PERMIT <br />:_"i•Y: is a '€?.-=i .4p<,.:?.•+,.. ?,, f :`.3' <br /> 9 tw^s°'t:•`'" rlhP ! <br />?,y=- i) 'riCt#..". ?_:.6_i.?- REQUIREMENT <br />TELEPHONE <br />DATE <br /> 1 certify under penalty of law that this document and all attachments were <br />ervision in accordance with a system designed <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER <br />tion or su <br />di <br />d <br /> p <br />rec <br />er my <br />prepared un <br />f to assure that qualified personnel properly gather and evaluate the information <br />Based on my inquiry of the person or persons who manage the system <br />submitted <br />, <br /> . <br />or those persons directly responsible for gathering the information, the informatio n ??? l PL ?? 1# <br />`7 J G® 8 <br /> submitted is, to the best of my knowledge and belief, true, accurate, and complete. SIGNATURE OF PRINCIPAL EXECUTIVE <br /> 1 am aware that there are significant penalties for submitting false information, OFFICER OR AUTHORIZED AGENT AREA NUMBER <br />CODE <br />I YEAR MO DAY <br /> TYPED OR PRINTED including the possibility of fine and imprisonment for knowing violations. <br /> I- <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) L": <br />iotT `, ,U t ++= <br />f C1• _.. <br />r -10 ?:N"),a1\1 or- <br />U'6 - <br />d?i =+`I I`:§ y r °"1 <br /> , <br />s,l <br />p'D 7 <br />' , <br />, <br />z? <br />r„ <br />? ' 3 1-lTi-lliq r+E- 3"1e?t•..Ii{?, . <br />+ , <br />r <br />3 o`?s <br />3 3 : <br /> t.. <br />,. <br />-Ui« <br />7. <br />%DDT'I•.?d ;i!= ti <br />ANY . <br />_ <br />.. <br />: : <br /> .« <br />l <br />t ,.-. <br /> fie.>0y•.f a=aYt=Orm. PAGE toF <br /> EPA Form 3320-1 (Rev. 3/99) Previous editions may be used.