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PERMITTEE NAME/ADDRESS (Include Facility Name/Location if Different)
<br />NAME
<br />ADDRESS c. d;'•: '.
<br />FACILITY
<br />LOCATION -a-F , ,-
<br />Form Approved.
<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES) OMB No. 2040-0004
<br />DISCHARGE MONITORING REPORT (D R) tr y, e.. ?R
<br />-JG
<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY r ?1 "r zl iJ €1.t . C. i- :"aFZ G t- "` t N
<br />FROM + I,. TO a I- t
<br />NOTE: Read Instructions before completing this form.
<br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION N0, FREQUENCY
<br />OF SAMPLE
<br /> EX TYPE
<br /> ANALYSIS
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS
<br /> SAMPLE
<br />StT?.
<br /> MEASUREMENT
<br />
<br />Y0 i ., tom. .., _.
<br />r77 PERMIT
<br />.,
<br />., is
<br />*• j - i I' u, I1>: 'REQUIREMENT
<br /> SAMPLE
<br />
<br />MEASUREMENT .'..,_ . ., '. ,:. ..
<br />
<br />?
<br />?- t t;
<br />
<br />1
<br />14--o
<br />(P
<br />:r a". ... PERMIT
<br />Tjj-: v t ?.?ri: REQUIREMENT;
<br /> SAMPLE . :,?.; t,•.;Y•. F:.n .?t= `?
<br /> MEASUREMENT
<br />jE'• PERMIT
<br />2 z--n: a L;;y = t}
<br />L- ..3 I.t?. L7 .f 1•2i.w 'uL REQUITEMENT
<br />DF.
<br />' SAMPLE {a: .;c ! i:•i:•a .ci::':r :-y.
<br />1 3/?(
<br />14-V t C?
<br />,12A5
<br />3 N, r.1n.. '•7 4 ._:',?)'- i"+.l + ,f MEASUREMENT
<br />{.. , PERMIT t
<br />r 3 '=!_) '! • t : t a.. REQUIREMENT
<br />t,y ?? l t SAMPLE 't•2-'is;? ,E•'a ... a :., .,
<br />
<br />I`y, ?- 1
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<br />119 _[:,.
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<br />2/arX
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<br />`11??
<br />;'+_ z t _. •, ._. ? :. ii_;,1; MEASUREMENT
<br />
<br />D-1 " PERMIT
<br />q I E
<br />2 ,. REQUIREMENT
<br />F F SAMPLE f. i. s r. , _ . .
<br />O/A
<br />/A
<br /> MEASUREMENT
<br /> PERMIT
<br />?•I- } t r,1 s. tr ?i ??3 5i?? REQUIREMENT
<br />
<br />! AMPLE
<br />0
<br />? 12
<br />0.01 Z
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<br />(? STS
<br />?t =ar } „• • , ?a,__ i!I MEASUREMENT -
<br />. v
<br /> PERMIT _ n .. ,. •: u "'
<br /> REQUIREMENT
<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certify under penalty of law that this document and all attachments were TELEPHON E 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
<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 informatio `
<br />
<br />
<br />?S
<br />submitted is, to the best of my knowledge and belief, true, accurate, and complete. n
<br />
<br />SIGNATURE OF PRINCIPAL EXECUTIVE 3
<br />
<br />t '
<br />l/?1 (3
<br />r
<br />TYPED OR PRINTED I am aware that there are significant penalties for submitting false information,
<br />including the possibility of fine and imprisonment for knowing violations. OFFICER OR AUTHORIZED AGENT AREA
<br />CODE NUMBER YEAR MO DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here)
<br />?: *.'r•. _ .. .. _. ?-;{t?.. ). ?.! _ ) ... i't 3 ?? .. Y I,_:.,.. ?_ I.?.; .3. ?, .) #" Li.. .. .Y... 3.. .". °'i:'•1'? ? ?s, :. M .. ... .. .mot" ?. L..) t ?. - t.,..> Y ?%.y_, ._
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<br />i
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<br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. rr ^^ ;'v'Fh.IS 1s? a 4-pa"'rtsform. . PAGE q.1
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