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PERMITTEE NAME/ADDRESS (Include Facility Na,ne/Location if Different) <br />NAME ^?f=f,t '.'. r'Y? ? F Na %' <br />_.3 <br />ADDRESS !,.W. INE.Zt <br />FACILITY <br />A "a <br />LOCATION P 0" <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />{{••??DISCHARGE MONITORING REPORT (DMR) <br />µ PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM ], T C). 0.? TO i. g; ij?:j d I <br />Form Approved. <br />OMB No. 2040-0004 <br /> <br /> <br />NOTE: Read Instructions before completing this form. <br />PARAMETER vr' QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ, FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE }as; : ' K . : v.• t'r='. 3:..... •:t ,? 4 :w1 <br /> MEASUREMENT <br />°L1sa?l:f k, ;l PERMIT ?Fa,...• _._ " <br /> REQUIREMENT <br />._? <br />.{ <br /> <br />•_ <br />1 IDS r iq <br />3 <br />2101 <br />? SAMPLE .r g.:.:f :. 't• .o .!'.'••;•; ...> 1 .e , ..:$• ? -•---•,> ? " ? <br />e <br />.. <br />... <br />. <br />.._ <br />+ MEASUREMENT a fgr? a <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />Z7. r PERMIT <br />-. .. <br />4 r..r..r .. <br />j REQUIREMENT v y. +?t» t t: f T xri r':s i < <br />S <br />" SAMPLE :t d3 i f ?? i. 3..4. ! I? S l .: ii =k s .. d f Go a <br />III Gt i. <br />OIL F r£ <br /> MEASUREMENT <br />0: PERMIT <br />r REQUIREMENT <br />t <br />7 <br />:T <br />SAMPLE <br /> <br />?3D <br /> <br />iP 3? t} <br /> <br />;Fxa5e <br /> <br />i a:• §3tik <br /> <br /> <br />TR LAN <br />fl3 ?' <br />MEASUREMENT <br />. <br />i <br />"r" 11 <br />PERMIT <br />"=Y S$ C-,,q aS 1l' { r REQUIREMENT tPjF) <br />}iD$ 9 t t-.. _. .., SAMPLE x:S ih:' Z srfi •? ,i: n..: i;a x...?''; <br />lIS "iAL <br />` MEASUREMENT <br />v PERMIT <br />b t r REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAMEITITLE PRINCIPAL EXECUTIVE OFFICER f 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 />p(' f <br />?? <br />? to assure that qualified personnel properly gather and evaluate the information ' <br />' <br />' submitted. Based on my inquiry of the person or persons who manage the system, <br />f <br />? or those persons directly Yesponsible for gathering the information, the information <br />peer?_ <br />d vi? <br />6` <br />GO' <br />accurate <br />and com <br />lete <br />nd belief <br />true <br />f <br />k <br />l <br />d <br />b <br />itt <br />d i <br />t <br />th <br />b <br />t <br />' <br /> p <br />. <br />, <br />, <br />, <br />o <br />my <br />now <br />e <br />ge a <br />su <br />m <br />e <br />s, <br />o <br />e <br />es • <br />SIGN TORE OF PRINCIPAL EXECUTIVE - --? -t=' <br />TYPED OR PRINTED 1 am aware that there are significant penalties for submitting false information, <br />including the possibility of line and imprisonment for knowing violations. OFFICER OR AUTHORIZED AGENT IAREA I <br />CODE - <br />NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATIUN Ul- ANY VIULAI lulus (Hererence aD arracnmenrs nere) <br />1: c r a•a` €t}?"' z r r 7P{` =rt t r i f 1 r ?y 4 t ? :?:T tU SJ,f T3FN• 'Or= #?ROI a 7N <br />PA:-i' ?' 3. <•iiii°.Yr=..t . ?="U1'?e _ `"D TO I HE= r! s?1i ? I a... r iM ts., IP.air.. 49 ririt.,/i-l •-• <br />p••r 5„}`:4 ... a?i^i 1 !A ";'n .7 1 IV i.... <br />,{ <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. ?) Cg- j / T.?? ?? l ?.rp T rm. PAGE OF