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PERMITTEE NAME/ADDRESS (Include Facility Name/Location if Different) <br />NAME Y <br />r i.t i? ; .`...r:'Y !'i •.. ti _.: .,eat.. <br />ADDRESS 1°, 4;rlt.'C;F <br />?.:?r r t-rl :":..i1'l t J??fi? -•-.i.' t'f ?.?, ?.sL?l?r,?f i <br />FACILITY Al s <br />LOCATION .,n-.rrr --i <br />a'l t ?> n. ...,-+ . <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO t. _ . <br />Form Approved. <br />OMB No. 2040-0004 <br />is .. . tie + °itl # T <br />5- T) <br />NOTE: Read Instructions beforWcompleting this form. <br />- PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY <br />OF SAMPLE <br /> ? TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />r+ ~w ??. l" V'7l?+?... .rl ,.? <br />SAMPLE <br />.. ..., .... <br />! ?"?: i, } <br />, .d J .?C i4'a3 f[` r <br />,.. 2.•u. •r <br />.... ,. <br />.... ..Y •k- <br />V 1 S? ?AaL. MEASUREMENT <br /> <br /> <br />_ PERMIT k-:z ,. i <br />% <br /> <br />3 <br /> <br />;r- <br />f .Cf:t? + tit i; Sw t:)f s E?;:, REQUIREMENT <br />t, <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 /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAMElTITLE PRINCIPAL EXECUTIVE OFFICER I certify under penalty of law that this document and all attachments were <br />i <br />i <br />i <br />d <br />i <br />h <br />d <br />i <br />d TELEPHON E DATE <br /> s <br />on <br />n accor <br />ance w <br />t <br />a system <br />es <br />gne <br />prepared under my direction or superv <br /> to assure that qualified personnel properly gather and evaluate the information <br /> submitted. Based on my inquiry of the person or persons who manage the system, J <br /> or those persons directly responsible for gathering the information, the information <br /> <br />accurate <br />knowledge and belief <br />true <br />and complete <br />to the best of m <br />submitted is <br />f FF ?v <br /> , <br />, <br />, <br />. <br />y <br />, <br />enalties for submittin <br />false information <br />ifi <br />t <br />i <br />I <br />h <br />h SIGN RE OF PRINCIPAL EXECUTIVE <br />E <br /> <br />TYPED OR PRINTED g <br />, <br />gn <br />can <br />p <br />ere are s <br />am aware t <br />at t <br />ncluding the possibility of fine and imprisonment for knowing violations. OF tC <br />I OR AUTHORIZED AGENT <br />/ AREA <br />CODE <br />NUMBER <br />YEAR <br />MO <br />DAY <br />UUMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all affacnmenrs nere) y <br />-. ; •- ` }r- p.• tt ( 1•'i" "1' Ii. <br />.... .., i. - .. .?.' 1 ..F... f h, V ED T . .1"i !?t Cf yam' _?. L ° r 'P 74 <br />L.• I ?t.3 t? -Erb FOR H ? :C T7 j 4},-1.. <br />.'''.. P-ii_ DA `.A7 'SN-1Af..Iw ?..: {:1i...lFTL. .1 :fit.) I•..s tj:E. :.? st y. ?..: ?. (.. ..i I?(.t.. ?. ??? ?i'i .te•. ?r, <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. ! _';; tz krtsi is 4 OI1T1. PAGE