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PERMITTEE NAMEIADDRESS (include Facility Name/Loccation <br />irf D_i.f. ferent) <br />NAME =I :i-,i` ,.:ta C;U? <br />t ,s? a tir,? rT r• <br />ADDRESS <br />'. .n <br />K -A: 5 <br />FACILITY <br />LOCATION,, ?, e .,...w <br />Form Approved. e <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) OMB No. 2040-0004 <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER ; a f. Y'ra 'aL5 <br />MONITORING PERIOD E= 1` I ?'. ?t'.'? „ "! ? ?.1)Sdd'F!v <br />YEAR MO DAY YEAR MO DAY <br />FROM TO feu 0 D ? °S C' c 'f :L 1 :sht. s <br />NOTE: Read Instructions before completing this form. <br />!-,'/'. <br />NO <br />FREQUENCY <br />SAMPLE <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION , OF <br /> EX TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ANALYSIS <br /> SAMPLE <br />"K <br />7W AL MEASUREMENT Sit l` <br />v <br />- PERMIT .. } b ....., , ! . ;',° . .. _. <br />(, e fi7- a 0.f;( ;js= REQUIREMENT ^ I G q - Pd: <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <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 />NAPAE(TITLE PRINCIPAL EXECUTIVE OFFICER I certify under penaltyur law that this document and all attachments were <br />z TELEPHONE DATE <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 N Q <br />I <br />?J' <br />{ p <br />Q' <br />°r?^ <br />Ube l fa.` Rased on my inquiry of the person or persons who manage the system, <br />submitted ` ?-^s <br />r g <br />';? <br />? <br />e . <br />the information <br />responsible for gathering the information <br />ersons directl <br />or those / <br /> , <br />y <br />p <br />d <br />l <br />t <br />l . <br />- -? <br /> comp <br />e <br />e <br />ief, [rue, accurate, an <br />submitted is, to the best of my knowledge and be SIGNATURE OF PRINCIPAL EXECUTIVE ? <br /> I am aware that there are significant penalties for submitting false information, AREA <br />R risonment for knowing violations <br />of fine and im <br />ibilit <br />i <br />l <br />di <br />th OFFICER OR AUTHORIZED AGENT <br />E NUMBER YEAR MO DAY <br />INTED <br />TYPED OR P . <br />p <br />y <br />nc <br />u <br />ng <br />e poss COD <br />COMMENTS AND EXPLA{{ NA I IUN UI-44{{ANY VIULA I IUlva??(44rsefer{ence an arracnmems nereq -A ZN- d.Ah"%1k i `ER .... , , tR v i ..Vt .?S :n:. w, .L . f. . r'f': IF, i9,:'. <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. <br />t <br />#° 4t i?-l]yaSsa 4 pRTT?£Otm. PAGE . OF , <br />t,