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Y?\ <br />E NAME/ADDRESS (include Facility Name/Location if Different) <br />bDRESS ?'i: i.? .: .1.... <br />FACILITY T A:, <br />r 1 :: <br />LOCATION 'J, <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR Mq, DAY YEAR MO, DAY <br />FROM - ° TO _. . <br />Form Approved. Y?4 <br />OMB No. 2040-0004. a <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 2 r . s?... . <br />?r " .. i . MEASUREMENT <br /> <br />PERMIT V <br /> REQUIREMENT <br /> SAMPL E <br /> MEASUREMENT <br /> PERMIT 4y <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 /> SAMPLE <br /> MEASUREMENT <br />PERMIT -: <br />REQUIREMENT <br />PRINCIPAL EXECUTIVE OFFICER I certify under penalty of law that this document and all attachments were TELEPHONE DATE <br /> <br />_77 t 1e ,yam <br />-! ?'/i/ L/ t? prepared under my direction supervision in accordance with a system designe <br />or <br />to assure that qualified personnel properly gather and evaluate the information <br />erson or persons who manage the system <br />uir <br />of the <br />R <br />sed on m <br />in <br />b <br />itt <br />d d <br />_ <br /> , <br />y <br />p <br />y <br />q <br />su <br />m <br />e <br />. <br />a <br />or those persons directly responsible for gathering the information, the information <br /> lete <br />t <br />d <br />d b <br />li <br />f <br />t <br />k <br />l <br />d <br /> . <br />rue, accura <br />e, an <br />comp <br />e <br />e <br />, <br />now <br />e <br />ge an <br />submitted is, to the best of my SIGNATURE OF PRINCIPAL EXECUTIVE <br /> I am aware that there are significant penalties for submitting false information, AREA <br /> risonment for knowing violations <br />ibilit <br />of fine and im <br />i <br />l <br />di <br />th OFFICER OR AUTHORIZED AGENT DE NUMBER YEAR MO DAY <br />TYPED OR PRINTED . <br />y <br />p <br />nc <br />u <br />ng <br />e poss CO <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attacnments nere) <br />' y`i_?:>"t:! L > v+ ? ,. i '? F, 0R Y iR, P. Rz- _ 11 iw.'?; t +I !' SUIP sL:C I i'0 3'-hL7 j:EN 01- P 4z;?.ii? R* ?>L.€?€I`S <br />PART 1, 2. ADD-t-I'10€`,rAI_ G4YA SKUL 13w TO )-!,'E. 1AV71FT'::"<! <br />0 Q 0F) S' /00 j'F 'sfi jr,P&rn. PAGE ;?-oF <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used.