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PERMITTEE NAMEIADDRESS (Include Facility NamelLocation if Different) <br />NAME ;t7. #. <br />ADDRESS ;_? .. •'., ,s = F,.;°' <br />FACILITY 4 7, <br />LOCATION <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 TO u <br />Form Approved. <br />OMB No. 2040-0004 <br /> <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY <br />OF SAMPLE <br /> EX NALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS A <br /> SAMPLE ;..., t: 7 <br /> MEASUREMENT <br />.. _ PERMIT t; 3: ... ?t .. , . . <br />• i REQUIREMENT <br />'. •!,• <br />sue'; 3. 4 . ?. i'ii.,,{`fi <br />r -a • ?' '_, (`',-. '' _ <br /> SAMPLE '' - <br />:k zr } <br />S={a MEASUREMENT <br />, , <br /> PERMIT <br /> <br /> REQUIREMENT` <br /> <br /> SAMPLE rc: >... ,. ... .. .: <br />M» .. •? - MEASUREMENT <br /> <br />, <br />>? <br />PERMIT <br />t: _ <br />..;< .. <br />_, .. 3. <br />; *.. ;. .. <br />.. REQUIREMENT :: <; <br />ti <br /> SAMPLE <br /> <br /> MEASUREMENT <br /> <br /> PERMIT ; <br />N f' <br />'"Yr Jr <br />1, REQUIREMENT <br />I• <br />S <br />t <br /> SAMPLE <br /> MEASUREMENT <br /> <br />_ PERMIT T . <br />pp r REQUIREMENT r--, , A' <br />:. Y ' I <br />I1• <br /> ' '': <br />?t? SAMPLE i..... ,. .. ...i <br />t: .... . <br />I.. ... <br />-- MEASUREMENT <br /> <br />t PERMIT a; z* r a n • .. i, +. <br />' <br /> <br />! REQUIREMENT. iL ., r:•,= <br />Lt ,... <br />`; r;;t, { <br /> <br />9 <br />"' ,. <br />. ... <br />r <br />- <br /> SAMPLE ) 9. 3. .. ... ":. <br /> MEASUREMENT <br /> PERMIT <br />;,. <br />?: 7nI R , REQUIREMENT <br /><: .. <br />?. 3:?' <br />.:"F. ? - <br />r ,x>•'Y t <br />1 L'--.. > ,. k`. w3 .r. - <br />NAMEMTLE 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 />aa....,? <br />'? V TG, 1 <br />' <br />-- <br />J <br />- to assure that qualified personnel property gather and evaluate the information <br />t <br />h <br />J <br />-+ 1 <br />f <br />T <br />Y, e sys <br />em, <br />submitted. Based on my inquiry of the person or persons who manage t <br />? the information <br />onsible for gathering the information <br />ersons directl <br />res <br />r those <br /> , <br />y <br />p <br />p <br />o <br />l ! ^a <br /> <br />- ete. <br />submitted is, to the best of my knowledge and belief, true, accurate, and comp &q) <br />SIGNATURE OF PRINCIPAL E IVE .? . <br />- .. <br />T <br />If <br />T? lam aware that there are significant penalties for submitting false information, <br /> violations <br />knowin <br />t f <br />d i <br />i <br />f li OFFICER OR AUTHORIZED AGENT DE NUMBER YEAR MO DAY <br />TYPED OR PRINTED . <br />g <br />sonmen <br />or <br />mpr <br />ne an <br />including the possibility o CO <br />COMMENTSFF AND EXPLANAIIUN Ul- ANY VIUI_AIIUNV Irreverence an auacnrttrrtw IICICL <br />t. .?-lily. . ... ... ... .r .. .7.. .., I ... c, ... «.7--.. •._ ... ... ,,. f. .i R ?.? •:. <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. <br /> <br />PAGE OF <br />_ -Vaq form.