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PERMITTEE NAME/ADDRESS (Include Facility Name/Location ifl)i erent) <br />NAME -. - t <br />ADDRESS VW fil trJ U•I <br />FACILITY <br />LOCATION 'r2e!S`Fi 'W'- y , 0 1 Ek <br />,'Y'i°.; luT? <<z:t=i : <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) Form Approved. <br />DISCHARGE MONITORING REPORT (DMR) M I ;'Mr OMB No. 2040-0004 ° <br />PERMIT NUMBER DISCHARGE NUMBER ; <br />MONITORING PERIOD CAF' 01\1'; C WIET £ ? 5 f' 1 1INiC Ft--,F+ 001• ri <br />YEAR MC DAY YEAR MO P;AY::FROM TO r. <br />'h iS'K• I?V M11 «! T1re {l?> , )•'{'Y- 1 I 'yr'I'? <br />NOTE: Read Instructions before completing this form. <br />PARAMETER z QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE;, MAXIMUM UNITS <br /> <br /> <br />F(7y t SAMPLE <br />y,•r ;::-k_•„s`.• <br />k•=?-•I i<.s..Z, <br /> <br /> <br />y <br />is is •i: fc•43l' <br /> <br />F. <br />$r:. :. . <br />i u::e <br />?:u iv CT"i:+G;)?=•:•"f ief°-5 MEASUREMENT <br /> a <br />_ <br />t? r PERMIT <br />REQUIREMENT <br /> SAMPLE <br />% <br /> <br />?y <br /> <br />1 w; <br /> <br />:F r ; ., <br /> <br />k . r J <br />R ? R 10 . A; ; T MEASUREMENT `'? <br /> *77 _v ...„ 3 avlz i;rf r .t br <br />?E-r- Ct.i)`37''lr-'•i•'I S B H i_if'a3 PERMIT <br />REQUIREMENT <br />I r 11Y 57 71.1A'' SAMPLE Jz 8 % ; I# = #it:, ki'.i ? Y: k ? s _r k x:.r sr i c 3 J <br />-HR <br />MEASUREMENT l/ <br />f <br /> <br />' <br />.... • -.. ? ... ,.y r-. ; ? <br />r ._ r <br />PERMIT '#^ .S•_ •?.?;_ .. .. ... r » <br />:. .. .... e't { ., .. ':: a . ,. g: t-:'?:- .. n s. ,3..- <br />? T}. k, .. ...... . ' 0 4.. : f' . <br />amt.=': w?? ii':i..t"•?7';a ? :'L.ai'Id REQUIREMENT - <br />?-.:..: <br />,.t F s F i i 1. JY: = <br />SAMPLE .ca : •..;?. ?...c• -VI I 4± ;r t•?-.:•. qc ?: r? n <br />0 •?• ::••5 :t• .i ." •?• •A• •r• ?• •tt• 5 c:+:r 3 <br />"'HR P PIF;- 'tom? S MEASUREMENT 10 <br />i t i v PERMIT ik IP z 'px T< **77-p •rr : •'z'•r..: T• TES' <br />'r-':"s???_ REQUIREMENT G x w i; ?'` ?•'1-'....._ - . 5 l a <br />r c)'; T C `:: 4 ?f r <br />' SAMPLE ® :? B ' : t c 1 <br />R I c-DAIF,#' 7 :'^ FiH'-. (sib w i MEASUREMENT i J <br /> <br />'.; I L7 P'EE' t.:. ^t <br />• ? <br /> <br />PERMIT <br />.. -. .,' ?: <br />?: , .:' •7;- l'?• <br />°' $s''12' <br />f'y . , .. ` . <br />s: -.... .7. .?. k' <br />`aY F . r n .-: '3.; k t ! r t <br />. i-F ? x,e t?) <br />f f :... _ . <br />.:.? ... Q . <br /> <br />5 ?_ X39 <br />r-nr N1 <br />REQUIREMENT <br />CT" <br />4i .r, T: A': SAMPLE <br />i ' Ct'?s?i N:?i l l L i) C ??i'`• MEASUREMENT <br />9 PERMIT ? s f ...- .. <br />_r-f.f?n9?;?ji REQUIREMENT r;Xi`. T <br /> <br />SAMPLE .. G• <br />%z f <br />s <br />?MdTt=j-;Ai_a.S C1"l:Sl 1\;';'-if" MEASUREMENT <br /> t <br />P <br />`i t v?Q ??' Sty P s.x <br /> PERMIT <br />wa:.E cc I"? tii?7`"T REQUIREMENT <br />3r r# <br />c rS?'F:.l? ;?z°' <br />T""XCT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certify under penalty of law that this document and all attachments were -`' TELEPHONE DATE <br /> prepared under my direction or supervision in accordance with a system designed <br />Ni.¢ l Q A-1 1-f <br />f/ to assure that qualified-personnel properly gather and evaluate the information <br />- <br />/// <br /> submitted. Based on my inquiry of the person or persons who manage the system, <br />or those persons directly responsible for gathering the information, the information <br />? <br />ow <br />ce submitted is, to the best of my knowledge and belief, true, accurate, and complete. SIGNATURE OF PRINCIPAL EXECUTIVE / v? (I J <br />i V 1 <br />1 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 possibilityof fine and imprisonment for knowing violations. CODE <br />COMMENTS AND EXPL.ANAI IVN Ur ANT VIVLAIIUrvb (rrererence an azracnmenrs mere/ <br />a iat; Y { 3',: F Di.: 2- . D7 "%''=`k"-T "Pik ^'CE DYNj E. X 7 THEi"v3r1r, 'S Ai :.e. -','A-T- 3IFF #s`:: f RES1 L-1 -ON `'"HIS x F_ <br />NOT, c =•K'0 ?r t:iii'-1tJ1T=TE= iJ?Jf f A?_s,_ 001X_ RP `r ! T X T' ,.?i-tI•.t?' i•J.S"i?:CA L i._Y S : t,"7, L).:?T' }3`f WN <br />r. „ ,•.l_ -f. y,'^"'ae J,1,S7 r i nf`•= )rt 't' •,~ 9 fi['P`t 4"YTfiC`I-I I` I i'l`t t?rl"=2 <br />"'P c ,^ 1StS! 4 8It TTTl. PAGE OF? <br />ir_ ;?? s ,_?•$ ?. <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used.