|
PERMITTEE NAME/ADDRESS (Include Facility Name/Location if Different)
<br />NAME CGA •Mhp'A:Nf i
<br />ADDRESS ?iF `??!yya'L;1 ittii :yy°.Ia y?}}tr-tt 015 F?0. Xrcm
<br />FACILITY
<br />LOCATION Mi T-
<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES)
<br />DISCHARGE MONITORING REPORT (DMR)
<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />FROM a (.i 01C.3 •). TO 1 o GO !21
<br />Form Approved.
<br />OMB No. 2040-0004
<br />?ak y f? NIA ?
<br />' ! r;SC H TO f A Ti.,.?l'I Y rya C R f".
<br />NOTE: Read Instructions before otm'pleting this form.
<br /> NQ FREQUENCY SAMPLE
<br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION , OF
<br /> EX YSIS TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ANAL
<br />y SAMPLE
<br /> MEASUREMENT
<br />
<br />>:ir;:?•fj?? ;, t? ` PERMIT r T .., ? .: do "' ??rti , z.'r!' - ; +• A
<br />?? shy:=t
<br />
<br />'
<br />REQUIREMENT
<br />;?.}
<br />Yty''
<br />YF':
<br />1,a
<br />s .z r b t
<br />3l
<br />t
<br />,;
<br />°
<br />m f F_ .4 ;: t^ r? f ;* .
<br />4,
<br />r ,
<br />f?tt r { f i 1'
<br />}: SAMPLE
<br />;_
<br />w w
<br />_ _
<br />.
<br />MEASUREMENT
<br />r
<br />gq'
<br />z
<br />?a
<br />. PERMIT }'•'?,.: if ?.?: :' 3:irt? =:sk,+:r° YF ' C:H it
<br /> REQUIREMENT s l
<br />at a;,
<br />F 7? "fie wk n, ' i. "?-
<br /> i
<br />r .
<br />.
<br />l. L.t::.•.'• 9 _'". ... SAMPLE ? fc? a .'# ry.3: x=f. 'w ! ? cb ={? ? „s?F ?
<br /> MEASUREMENT
<br /> PERMIT =9•.i. _i_-:'t q wrf.;• :. :w ?.. agac.Yv•°t ^'y r t Q• °s l s?ii., r
<br />g 1 vP aasro?C: t. _ q . fg REQUIREMENT rK #^ t i ; /v t? i F i"« 'v'Ii
<br />111' i r ,ia
<br />k` ANF
<br />: SAMPLE is k»•A}Fc r"r ? # #3?t is E 7 iEd <.:r 1 Sri: F* n 3°?:
<br />s
<br />.
<br />MEASUREMENT
<br /> PERMIT .:.:3••2$?r•ti. ,9p ,«i•`?'t `x 'rL •t't'IIi' ?t :t•k .r•€ •t'r `r; 5't`fi•.s«k:•:. ?, ?1 t i't N. ?-• t4' .;,; •.Ti
<br /> REQUIREMENT
<br />;
<br />`t 3°
<br />of k1 ' q r I
<br />r .•a : j
<br />;A. «
<br />Y -.Sk I :. P ^c ,
<br />D ye i r
<br />s=",.,ti's. r ?l 'wfer,'< }L} lt? SAMPLE € D sS .S 3: «f i,??.? v?F3: l s;..
<br />' MEASUREMENT
<br />F? i? ?
<br />4 r 113 7- L_tOkl l "`
<br />.
<br />
<br />
<br />n
<br />"")
<br />Z
<br />
<br />PERMIT
<br />
<br />
<br />r??+
<br />
<br />k"?
<br />
<br />t
<br />$»
<br />
<br />
<br />
<br />.fi•.'
<br />
<br />
<br />
<br />st
<br />
<br />
<br />
<br />tj
<br />ids ?t
<br />,
<br />, Sk+a?? i}
<br /> REQUIREMENT .4q+ z ,1• r
<br />€µX D9 TI`?TA
<br />E SAMPLE y ,' ii"ra ?•fi^ri4 «. ;. ry .rnti +itti
<br />;
<br />, MEASUREMENT
<br />,D
<br />q
<br />?
<br />•o PERMIT r?? :<
<br />3 fr i r w•.. "aYr? '" c;??t i! e i' a '9
<br />i} 2 ... .,
<br />. ,
<br /> REQUIREMENT x r
<br />rif `nA 5 :.:rt 1 Mill
<br />04-TI
<br />1,1
<br />s`=: !.
<br /> . ' -
<br />1
<br /> SAMPLE : Ci ` #3F Y 1 d ?c : X F•B tf r i ± :_••, ;. .{:ci: t
<br /> MEASUREMENT
<br />-V L
<br />
<br />PERMIT
<br />
<br />t3 l``i €1 k
<br />
<br />a = g
<br />
<br />rY s i .,
<br />
<br />f w?.:: «.
<br />
<br />E, .. 1. -.
<br />
<br />iii ?
<br />M
<br />I t r
<br />
<br />i ? t.t;6°"
<br />3 11C)6 6
<br />"
<br />REQUIREMENT t
<br />
<br />1 r ;
<br />Ia'
<br />
<br />a Sq '
<br />
<br />t: ts;
<br />
<br />l sU"S' R t C
<br />
<br />1
<br />t=ce }'r
<br />,..l q =1t rat:
<br />i• . .t
<br />?NAMEITITLE 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 />
<br />I try v
<br />°" V^•?. 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 information
<br />'
<br /> l
<br />t
<br />d
<br />•" e
<br />e.
<br />comp
<br />submitted is, to the best of my knowledge and belief, true, accurate, an IGNATURE OF PRINCIPAL EXECUTIVE e
<br /> I am aware that there are significant penalties for submitting false information, G AREA
<br /> vi
<br />tions
<br />i
<br />l
<br />i
<br />t f
<br />k
<br />f fi
<br />d i OFFICER OR AUTHORIZED AGENT NUMBER YEAR MO DAY
<br />YPED OR PRINTED .
<br />now
<br />ng
<br />o
<br />a
<br />mpr
<br />sonmen
<br />or
<br />ne an
<br />including the possibility o I CODE
<br />II
<br />atlawuncnw nc?c?
<br />COMMENTS AND EXPLANAI lulu Ur ANY VIVLA I1UN0 (r7C1crttlrlGC. a11
<br />VYENY Gzj. ' ,CT •'! 0 F??..''14=• Z)ON 07 -F,0 '37 RIEQ•UI,?;P,=t'¢ -o t."I S -,j
<br />t ' r?{7i
<br />+AY;.c,., ut t__ . r 1 .? t.lo "? r * ?
<br />"m• 3 9 t
<br />I. i'AI!' 0\Dnsj r1,,W- A':A 0 fie"'` it31:0N OTT'H• Jk1 4533€-'a.i?PS,
<br />PAGE
<br />EPA Form 3320-1 (Rev. 3/99 Previous editions may be used. hi 1 a,4g-f01'ITI.
|