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<br />PERMITTEE NAME/ADDRESS (Include FacilityName/Location if Different),
<br />NAME
<br />ADDRESS i,%'i-I-TRLWINO PROJECT
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<br />FACILITY H ' 1, 3 . f,; t 'r: "j ,J-,
<br />LOCATION.Mt=3 d 2rr
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<br />Form Approved.
<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) _ OMB No. 2040-0004 k
<br />DISCHARGE MONITORING REPORT (DMR)
<br />UDR DW)
<br />PERMIT NUMBER DISCHARGE NUMBER F T, NtAL ACA
<br />MONITORING PERIOD Gi ?RU;V! rC IWI TE S" + ? IVG FOR 001Pi
<br />YEAR E!iM YEAR MO? DAY aid F°_t:?d1`3?Fn FROM TO
<br />NOTE: Read Instructions before completing this form.
<br /> NO FREQUENCY SAMPLE
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<br />EX OF
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<br />REQUIREMENT
<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER 1 certify under penalty of ;aw that this document and all attachments were - ? ? TELEPHONE DATE
<br /> direction or supervision in accordance with a system designed
<br />azed under m
<br />
<br />b' y
<br />prep
<br />to assure that qualified-personnel properly gather and evaluate the information
<br />h
<br />S
<br />j e system,
<br />submitted. Based on my inquiry of the person or persons who manage t
<br />or those persons directly responsible for gathering the information, the information
<br />submitted is, to the best of my knowledge and belief, true, accurate, and complete.
<br />
<br />SIGNATURE OF PRINCIPAL EXECUTIVE
<br />
<br />-)u f t (?
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<br />
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<br /> significant penalties for submitting false information,
<br />I am aware that there are THORIZED AGENT
<br />OR A AREA
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<br />U CODE NUMBER YEAR MO DAY
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<br />including the possibility of fine and imprisonment
<br />COMMENTS AND LAPLANAI IUN Ur ANT VIUWI IUIMQ (FIVIUM M au aua? rnncuw nc. c?
<br />> ,. J?TA?'i_.... 'S S'`' - s"MC-r-DUPP RT? LOiwx:ST % n N?It ICI STA Ir"T? 'T' CAI-.!-Y Si:.E,'_F ?DIFF
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<br />I:?'? J-ra .NIQ CTJ )F 'T", n :-I T Tt CiH C'11RON t,_IX TEST I 1 „D DMIIN3
<br />BE T ?:EEN TES C;Lr:?4`d'• 1) S10-10 COTE '.c'.:'. Qr` t
<br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used..; f IYt•?}y?jpiIri, PAGE OF ca
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