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PERMITTEE NAME/ADDRESS (Include Facility Name/Location ifDieren <br />NAME t c ' i <br />ADDRESS'': <br />FACILITY .. ; i - <br />LOCATIONt.:.'I J <br />F <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) Form Approved. , <br />DISCHARGE MONITORING REPORT (DMR) OMB No. 20400004 <br />- PERMIT NUMBER DISCHARGE NUMBER - ?+?''=?I-- ' rte, <br />'V T- <br />MONITORING PERIOD <br />YEAR MQ, Df1Y YEAR MO_ <br />F t^r r7 „fp { S <br />FROM J _•. TO t <br />NOTE: Read Instructions before completing this form. <br />PARAMETER - QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY <br />OF SAMPLE <br /> ` TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br />.? _ .. ` Kt• .r't_ , r -3. ? ? '?' rl• :J",f' <br /> <br /> <br /> <br />< :' <br />«.t f . _ ,3.. t <br /> <br /> <br /> <br />..t...... <br />r.... , ,. <br /> <br /> <br /> <br />}..? <br />:..., .r4 77 <br />,? <br /> <br />. <br />.... { <br /> <br />... i <br /> <br />t" <br />_ PERMIT <br />SEE vC= F ,I F , "° " :_?...' '.°! REQUIREMENT ?: p.. ._, ._ r. <. . <br /> SAMPLE _ <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ` <br /> REQUIREMENT - <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE ' <br />s <br /> MEASUREMENT <br /> PERMIT t - <br /> REQUIREMENT <br /> SAMPLE x <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER 1 certify under penalty of law that this document and all attachments were <br />' TELEPHON E DATE <br /> system designed <br />prepared under my direction or supervision in accordance with a <br />S? r7f LrAJ / ? ( C jJ N <br />t( t'•? C 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 /> or those persons directly responsible for gathering the information, the information <br />submitted is, to the best of my knowledge and belief, true, accurate, and complete. <br />io <br />i <br />i <br />f <br />l <br />i <br />f <br />SIGNATURE OF PRINCIPAL EXECUTIVE ??J s ?'iy { <br />/`? r ?GP fh <br />(f ?,p <br />L <br /> n, <br />ng <br />a <br />se <br />n <br />ormat <br />tt <br />I am aware that there are significant penalties for subm <br />k <br />i <br />i <br />l <br />i OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br />TYPED OR PRINTED ons. <br />now <br />ng v <br />o <br />at <br />ncluding the possibility of fine and imprisonment for CODE <br />COMMENTS AND EXPL.ANAI IVN VI- ANY VIULAIIVNa tnererence an al[acnmenrs nerej f 2 <br />7. 7 <br />..r t.w l.. `}'.r. '?>~. 1.iL,. _.? ,.. ._.'..t..t i <br />_ r' <br />EIDU - <br />r-1 R 11 1 f l :C; rtJ .1,'j <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. j l` !?! a )g;t§ 41.0ai c rm, PAGE t OF