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PERMITTEE NAME/ADDRESS (Include Facility Name/Location ifDierent), <br />,.7 <br />NAME CL <br />ADDRESS''1'l I Ru.-gP.31W-D ra-.(.: t`C f <br />HUCL co <br />FACILITY <br />LOCATIONS co 6S <br />( -f=,. = rt 3Yt 4 .•i.t'!(i?C 1tE'?'f f <br />s <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) Form Approved. s <br />DISCHARGE MONITORING REPORT (DMR) K, i MO OMB No. 2040-0004 <br />PERMIT NUMBER DISCHARGE NUMBER -F 1= T N f_ N'Esrl <br />H fwli?i 1 i ?? i •3'EET- NIG FOR i; M A <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO ? a r ii iG# NO D I Srvf-•sARO 4 ? x 3i & i <br />NOTE: Read Instructions before completing 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 /> SAMPLE <br /> MEASUREMENT <br /> <br /> <br />.7 <br />#a1 <br />:.?. .. _ p <br />t•; L?4 <br />il_. ', <br />r:'r <br /> <br />SME C"J"vi:r'EF "IS BF_I..f.:,J PERMIT <br />REQUIREMENT <br /> <br />Y. `: ',1 !? <br /> <br />l':?t•t. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT a> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT r <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE L <br /> MEASUREMENT <br /> PERMIT <br />[R <br /> EQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER : cattily under penalty 'Flaw that this document and all attachments were 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 E/ <br /> submitted. Based on my inquiry of the person or persons who manage the system, <br />the information <br />athering the information <br />onsible for <br />ersons directl <br />res <br />or those <br />- <br />?.{ <br />/ <br /> , <br />g <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 />r <br />( ( <br />/ <br /> I am aware that there are significant penalties for submitting false information, OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br />TYPED OR PRINTED including the possibility of fine and imprisonment for knowing violations. CODE <br />COMMENTS AND EXF'LANAIIUN Ur ANY VIULmiiuma Iriererenue an auaclrln=n1a 11=1=1 <br />- 1 i-I: DET44 _,"E?. (". 3 z"ET PROCEDUPY2 RTP 4_0W',r-:S f A WHICH -STA T iS f-Yt:Ab.. _`t 9101,11F ?} # r° F <br />rr-,..?-?•p 1='-y?;•i. t .i.. •-?. - .f?.?s { t E RP. USING 9 ?S •q•p?/•+ ,?•+ ON •?^ 't MAR. <br />L° Iv:S i? le.Y ?.si 4.- '_. i? )= „L:t. f ?. ?,G5 *C C,').E ),r- ts. iT t Y't\„-i-4 CI-1 N T OX TT. _j f R,1:17 .. E) PAGES OF <br />Lairt- 3 C-b L:L s9 1 TEST S? <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. 1`02-220 O'TV331 •? '? db-f brm• <br />.,31