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PERMITTEE NAME/ADDRESS (Include Facility Name/Location if Different) <br />NAME ;?? ,.;?>• lj•_I t' 4 `.i t }Y'il- dr.^ v.-t i? <br />n.'•I`$ <br />ADDRESS <br />FACILITY f V'H _ <br />LOCATIONola%T.E!AAY rr iK?.52-'? <br />t <br />Form Approved. POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) OMB No. 2040-0004 ` <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER F - <br />MONITORING PERIOD F ST RN NT DNCHG r0 I MNASDEEN C R <br />-` <br />YEAR MO DAY YEAR MO D AI( <br />FROM TO ** 1XU r`i, x"a? 1 ( tea^ir <br />NOTE: Read Instructions before completing this form. <br />PARAMETER 'QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY <br />OF SAMPLE <br /> EX <br />ALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE- MAXIMUM UNITS AN <br /> SAMPLE r? ,, .. } r _-F° 3 {t ''•`^` Za <br />Gj5 <br />:. <br />D & S' 0C <br />1 1!2:v MEASUREMENT QV <br />, . <br />_ PERMIT fr? k #. .. s:: E,r: t z t <br />EF z=1...1JE? F "•y.A4 I-7 REQUIREMENT <br />c 1_ ` t`, ; t , ") <br />:.:..:. SAMPLE <br />? j ?.:. <br />-.. ,:.?. ?.: <br />?:: - <br />kvt <br />? ? ? <br />?- d ? <br />paw <br /> <br />1 <br />?? <br />? ? ? <br />C ? MEASUREMENT <br /> 1t t <br /> , tF r.b . <br />' PERMIT <br />. ... K s; ,rt i r i.} ' )t... t :. IJI ! ? . <br />FFl 6 .LJE't'I <br />r (7F3,i29S ;dK Ll!JE REQUIREMENT <br />JI3lar "/. ;` SAMPLE w'..:?ie: E:t li t^ $f 4.#« ® `Y ? ,??b <br />?fy <br />3 ur MEASUREMENT C <br /> <br />r _< ;- <br />a <br />t# <br /> <br /> <br />F4t <br />?. <br />mot, <br /> <br /> <br />• <br />% <br />ti <br />t w <br /> <br />` <br />- <br /> <br />E?"(-LUEI' `,- GcrtO- S `?` Al-U PERMIT <br /> <br />REQUIREMENT <br />u'?'?'jis <br />• }? .}. . {S <br /> <br />.. p? <br />Lt'?{ Y ?- . . ?``i <br />!•I ?tJ ??! _ <br />1;,-1t { f F ? <br />_ <br /> <br />- <br />• T -' 7j. t <br />:.. <br />SAMPLE F Tt' ='T .'< <S w y` :-: :s, ?..? :.r..x.. •`T' a3.7+ '.if `Y"'".f ? O /-?' n <br />4- )1 1 G:L <br />t s f <br />???jj 7 <br />1 <br />x A Q <br />/? <br />n t-GC7VffF,* P-- E <br />7T0 T F- l MEASUREMENT / ?f }L/ /?J CJY <br />_. <br /> <br />r <br />......•. <br />?.«. ..-x ... <br />at- ?!- - .:....,.. <br />::. t <br />-.• Y^ c <br />s <br />is <br />. <br />ar L la'71`?T 'k'.-';t'OI-;-5..t" V ?.U PERMIT <br />REQUIREMENT <br />A SAMPLE <br />TOTAL R EC0V ?(=1aLC MEASUREMENT <br /> PERMIT -t r <br />R:.? 1OF,S Vi UEE <br />1~1~tt._4t REQUIREMENT j } - t i ..' fr7 D IA x L t- U(.'^,l!_ <br /> SAMPLE r ... <br />3Y <br />7 77, <br />a .. of <br />M1 <br />410 <br />t <br /> MEASUREMENT <br /> ." e,z? <br />':C <br /> <br /> <br />• PERMIT <br />REQUIREMENT <br />3# sc :; <br />I_.fi r 'situ <br />°c r? <br />i' ?r <br />L)Gi+i., <br />4 <br />T - •n S -: 5 i', [ .-tiff <br />SAMPLE 't . .:•"?w•:1' :. 'il .. i. wy. 7 -f •eY'i*'.?' 'Yt' f? <br />2, G ' !^J( <br />t(p' <br />/ <br />)/' /} ^. <br />{ <br />(? <br />l ? <br /> MEASUREMENT ?A f <br />` <br />? v <br />{ <br />? - _ <br />-aE! ? c PERMIT <br />rrr <br />:-.:.t` "6 i ?:'• # <br />F r UfE-F 1T C--c: 0sS r: REQUIREMENT t wit '.3 ry AV O ! .A I L w f U f _ .. f <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certify under penalty of law that this document and all attachments were TELEPHONE DATE <br /> ervision in accordance with a system designed <br />direction or su <br />ared under m <br />" <br />" <br />t p <br />y <br />prep <br />te the information <br />l <br />l <br />th <br />d <br />l <br />? <br />• <br />q,? p ?.rF A t ?? <br />t <br />(?, <br />sl <br />C 4_r C 6?3 V <br />f L er an <br />eva <br />ua <br />proper <br />y ga <br />to assure that qualifiedpersonne <br />e the s <br />stem <br />ns who mana <br />r <br />i <br />i <br />f th r <br />- <br />. y <br />, <br />g <br />e person or pe <br />so <br />nqu <br />ry o <br />submitted. Based on my <br />the information <br />the information <br />r <br />atherin <br />ibl <br />f <br />tl <br />di ?y <br /> <br />/ <br /> <br />v , <br />g <br />g <br />y respons <br />e <br />o <br />rec <br />or those persons <br />submitted is, to the best of my knowledge and belief, true, accurate, and complete. <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />'-] o <br />1 1 I lJ t o G i <br />VI <br /> significant penalties for submitting false information, <br />1 am aware that there are OFFICER OR AUTHORIZED AGENT AREA <br />TYPED OR PRINTED , <br />including the possibility of fine and imprisonment for knowing violations. CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXYLANAI IUN Ur ANT VIULIAI (rtrtrrrncc an aua?.nn?cnw nc?c? <br />PAGE OF,, <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. (jC?(Jt? ,? ?5 ;j ]jam l?SS 4ptgprm, ;