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PERMITTEE NAME/ADDRESS (Include Facility Name/Location if Different) <br />NAME ',;. t ..., y,. a. t> + ., Lrt.3;-E <br />ADDRESS <br />??!• I' I d' r i 2. _ .. i= ._.. W iiii .'. sue.. t <br />FACILITY 4 ` i" ` <br />LOCATION <br />Form Approved. <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) OMB No. 2040-0004 <br />DISCHARGE MONITORING REPORT (DMR) III ; NO'R <br />•_3C. > <br />PERMIT NUMBER DISCHARGE NUMBER" tF 1s <br />MONITORING PERIOD 7kit? T i'; <br />YEAR MO DAY YEAR MO DAY ,, <br />FROM 7 i. TO +.a t <br />NOTE: Read Instructions before completing this form. <br />PARAMETER^ _ i QUANT ITY OR LOADING Q UALITY OR CONC ENTRATION Np• FREOOUF NcY SAMPLE <br /> EX TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ANALYSIS <br /> SAMPLE E3 <br />I 6 (? 0 Sa`t <br /> MEASUREMENT <br /> <br />E'C_• r r # PERMIT _, .. > :. <br />kr i ,J 7_ +nt y: 'REQUIREMENT; '. t e s s <br />T SAMPLE ' 2I2,A GeAr:5 <br />c; <br />1 <br />• <br />' MEASUREMENT <br />»(,+ <br />;, <br />. <br />, <br />y?•? - PERMIT : 'r' .... <br />Pub0 I ?i +1ri s <br />i FFL t REQUIREMENT <br />.. <br />...J .. _,_ _.,.'.. <br />50i <br />SAMPLE <br /> <br />2j3 <br /> MEASUREMENT <br /> <br /> PERMIT <br /> <br />„ <br />L <br />L <br />_ . t • ,e ' z <br />I?.M 1 '? ?Y7-J1t t .,.? -_ '•J j.. f! REQUIREMENT ...r - <br /> SAMPLE <br />T- -• rJ S MEASUREMENT <br />s i ? { y .., <br />.. <br />:. <br />?•; <br />'' <br />J`•`Jw.'J PERMIT t{+? <br />L <br />F <br />T <br />E f ,::t.? <br />r <br />€- REQUIREMENT <br />_ SAMPLE --'r SS ., ZQ 32 :i / ?f,AQ <br />=' MEASUREMENT <br />:i <br /> PERMIT <br />frrr ` t!?_':i W t' REQUIREMENT <br /> <br /> <br />' <br />SAMPLE <br />MEASUREMENT <br />? <br />A <br />t,- r r .:1 <br />r -s•a <br /> <br /> <br />aST <br /> <br />! <br />I <br />w <br /><L PERMIT <br />. <br /> REQUIREMENT <br />f <br /> SAMPLE <br />3646 <br />?6 <br />? go <br />G-erg <br /> MEASUREMENT <br /> <br /> PERMIT <br />t-1 1 ;• "t t i ;j% - REQUIREMENT <br />' <br />TITLE PRINCIPAL EXECUTIVE OFFICER I certify under penalty of law that this document and all attachments were TELEPHON E, DATE <br />NAME/ prepared under my direction or supervision in accordance with a system designed <br />(? V r` 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 /> the information <br />onsible for gathering the information <br />res <br />ersons directl <br />those t ( <br /> , <br />p <br />or <br />p <br />y <br />submitted is, to the best of my knowledge and belief, true, accurate, and complete. <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />f ? <br />f <br />$% I am aware that there are significant penalties for submitting false information, <br />UTHORIZED AGENT AREA <br />YEA <br />TYPED OR PRINTED including the possibility of fine and imprisonment for knowing violations. OFFICER OR A CODE NUMBER R MO DAY <br />i COMMENTS AND EXPLANATION UI- ANY VIULiarlvrva (riererence uit auaoniaenw nmc? _ y ry <br />...,- , :l t t ,•' T I ' ii ,ti z .Z ` `.'Yr' sr I-+it*. ; 1 »I' r t • ss S.. i. s _ ..._ I1.... 1 <br />}air ~y y.r.., PAGE -OF <br />EPA Form 3320-1 (Rev. 3/99) Previous, editions may be used. c , r15 ls) 3'-p-fOriTt.