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?i <br />EE NAME/ADDRESS (Include Facility Name/Location if Different) <br />SS - ... w3' f.. . l ,.. V <br />•iACILITY <br />LOCATION <br />lt: <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES) <br />DISCHARGE MONITORING REPORT (D R) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO-, PAY YEAR MO-: DAY. <br />FROM TO <br />Form Approved. "?* <br />OMB No. 2040-0004'` <br />" <br />NOTE, Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO• FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE ._ ..._ ,. > . .. :., .. .. A :r t <br /> MEASUREMENT <br />» „C « , <br />PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />_ MEASUREMENT <br />t, PERMIT <br />I <br />"?e!' Q;Fli iF: <br />REMENT <br />REQ <br />. UI <br />t IL_ } - , >^; w i i =ti3 SAMPLE <br />r?r. <br /> <br />l? <br /> MEASUREMENT , 1 <br />Er?A. - It !,? ?: r°3 <br />PERMIT . ... ., .. _. _. -, . 'ir s},e.` . ., t? .. ., ...,. <br />p.i•i" t...L':'.I?` , {s'l??.t 7i+(::..?_.i'. REQUIREMENT.. ..'4'S'k t ..1.,. ?'• t'v'.a ....'a "?;,...> ... ,.i? ?_ <br />. . t <br /> SAMPLE e_r;:.. a r z r „. __ <br />TOTAL ??, E ? '•?`" 1 ?9°3Q.? MEASUREMENT <br />;"0-; %w C# C PERMIT <br />EFFLUENT f^i'OS '"It`-lal, LIF REQUIREMENT l:'T L <br />. 1 _. .:?t.f t .h.. r <br />SAMPLE yi.. . .?..fi.+,. -. ?.. _• ? A'.. ?'.tl"'. 'K :5 ., '. L•TJ 6 6 ? <br />> <br /> MEASUREMENT <br />tcz. L, w PERMIT r r+. <br />t.. ,.T + t S \ fit; <br />« t '?i: <br />'?Uid <br />REQUIREMENT ' ?t :b• <br />» <br />\ <br />01 SAMPLE <br />i"HRURF? MEASUREMENT <br /> <br />• <br />.al' "e C: 43 PERMIT <br /> <br />• <br /> <br />.0 <br />ut <br />t?. Ur_i+i t sli?J -"a'Cal*.?be REQUIREMENT J« ?_ `l c" c=> C"L' <br />f. SAMPLE ;r Y:.; .r >: os o:: yr + : r <br />i` LX3 t'k:ti MEASUREMENT _ __ <br />~ <br />•'Aw1, ? . 1 • i PERMIT <br />' .:'?. .. ?. .. ?. 5'. «"'? . i : <br />»l IN # <br />fn?t? <br />~'L{?t`I "i+F1i?w`' 7 ??141? .?y i'n <br />REQUIREMENT ii ?i y{••?. w?,-f jnl1 ?.fr. {'R. :l M..;.' •L,?, iii \:.p• i. ,.. <br />NAMErnTLE PRINCIPAL EXECUTIVE OFFICER I certify under penalty of law that this document and all attachments wer e TELEPHONE DATE <br /> <br />?,±'??•• ? <br />>!?"r?"i0? ?,,y? <br />` prepared under my direction or supervision in accordance with a system designed <br />to assure that qualified personnel properly gather and evaluate the information <br />t <br />/ .c= CC r Gc_ N d <br />/ submitted. Based on my inquiry of the person or persons who manage the system, <br />"`^••? <br /> or those persons directly responsible for gathering the information, the information <br /> submitted is, to the best of my knowledge and belief, true, accurate, and complete. SIGNATURE OF PRINCIPAL EXECUTIVE S`bs'5" k <br />?? y J <br />TYPED OR PRINTED am aware that there are significant penalties for submitting false information, <br />including the possibility of fine and imprisonment for knowing violations. OFFICER OR AUTHORIZED AGENT AREA <br />CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference aft attachments here) <br />, INIEO?f? E'":N Si..sB?,i?'C TO U.gDE'N OF ?F ROO €?'Et:?)KI?ENJY .a Al <br />t.r t ark?i,t'"k ,'sf ?'".,Nt1;1 ...f ',_' mot.; L' ..?;, 1:. <br />t-:? 'j:.l _.I .... ?? 1?.. k'?,.. i ?r?? ... i:,..f FUR, . <br />Jw i QT ADD -' l'.t « I, _ ot.? f3gµt 27- l 7 t , ?e "='`." _ ... ?. 1.1 T ?, o ?. 'i 1?`I <br />19t S t ir...t; , t I-3: S;.rr Pf C) TO i?1t <f t??, ;?i r:? •? <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. if ?nS 1P 9'4'- jS11't34OT'fTl. PAGE 1OF