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<br />PERMITTEE NAME/ADDRESS (IncludeFacilio,NameTocation ifDierent <br />NAME I T,I:._E=Y1' r 1 iFt 3'__1? }?L d,(•'"'. <br />17. <br />ADDRESS WHIRt. I1ND P,14,Q 2C i I <br />FACILITY <br />LOCATIONL: A T E€.t-c"3 e co 3_l 5w': <br />t <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) Form Approved. <br />'f <br />DISCHARGE MONITORING REPORT (DMR) I M v17- OMB No. 2040-0004 <br />u \ \ JUBR DW f t. <br />PERMIT NUMBER DISCHARGE NUMBER F - F I NAIL fdiL_:`3 A. <br />MONITORING PERIOD C3-1RUN I C (h1F:T T'--,T l iN , ? ?IZ 001A <br />YEAR MO DAY YEAQ MO, DAY `" 1 <br />FROM J . TO a 4. ; a i # (w(C at ?: `T'? . chk;J' C? 4 A. :. <br />NOTE: Read Instructions before completing this form. <br />PARAMETER - QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY <br />OF <br />' SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE;,. _ MAXIMUM UNITS <br />.r^a',;'r...Y <br />• ?}' > <br />SAMPLE .i',t.. .•1:::f'•?; '_:-i•-b'..r.,. ?k %?f.I. <br /> <br />3SIh'.' IF t"I'YY.0'tla-. <br />MEASUREMENT Y? <br />l? <br />z r. i PERMIT 1 ... .. - $c $L f= S s:.1 s:. C )FI Dig zi.... <br />?G?i?ski T 8?_::9f REQUIREMENT kc'z: r 1i'<__ 1'.t;(EsT 'f <br /> SAMPLE ` <br /> MEASUREMENT <br /> PERMIT - <br /> REQUIREMENT _ <br /> SAMPLE <br /> MEASUREMENT p0. <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 L <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER l certify under penalty o'T'law that this document and all attachments were TELEPHO NE RATE <br /> prepared under my direction or supervision in accordance with a system designed <br /> <br />,?+ P A,.,. AN, JOAJ q <br />-'7 _T 1 <br />/ f r? <br />to assure that qualified personnel properly gather and evaluate the information , <br />stem <br />ersons who mana <br />e the s <br />f the <br />er <br />on or <br />i <br />i <br />d <br />B <br />d <br />i <br />b <br /> <br />t^ <br />J <br /> , <br />g <br />y <br />p <br />p <br />ry o <br />s <br />m <br />tte <br />. <br />ase <br />on my. <br />nqu <br />su <br />the information <br />onsible for gathering the information <br />ersons directl <br />res <br />or those ti <br /> <br /> <br />" , <br />y <br />p <br />p <br />submitted is, to the best of my knowledge and belief, true, accurate, and complete. <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />? I c <br /> <br />v <br /> <br />TYPED OR PRINTED I am aware that [here 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 <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND F-AFLANAI IUN Ut ANY VIULAI IUNO (rrererence an ar[acnmenw nere/ <br />„'"' ;.. { i. - - rtes; +- ,:l e i. :s tiS P. IS v a l`a'i' '*k)IF RV R?=S+LO .:S s?"K T1-' Q"{' `= j_L. IF <br />z -.r Ir r? s r0 1 1RPT _f 1 rWEST %. val.. y <br />it.J 1 ) f.r I..r 1 a L t '1 t:' t..v i,= rt L! {° ?t L } 0 1 .v".. L, t ?' ?_ r t rl,.i 1 G1 C+_? .. {?.1k - :^•/,S ?.. r wr ,"Y s-'?-- Z.p'4 S <br />NOT, r, yq / f <br />T1-3X T1 sT E7#? T T Q +, J <br />ii a c b'- t F Iz'iTFah e s aa.+>- P il !' <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. r) s 'Ea0 0741ISrS' -4 part form. PAGE Z, OF S?