|
PERMITTEE NAME/ADDRESS (Include Facility NametLocatiion if Different)
<br />NAME
<br />ADDRESS
<br />
<br />
<br />FACILITY
<br />
<br />'i ?; , 3 ?'f }$ r
<br />.yt
<br />LOCATION
<br />TA 6.1? -I t-tlz!
<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES)
<br />DISCHARGE MONITORING REPORT (DMR)
<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO. DAY ??i AR MO DAY
<br />FROM ` O C)"7 - l TO l
<br />Form Approved.
<br />OMB No. 2040-0004
<br />It$.-)•$s:'4 7.. ..y?,4 ..?c.
<br />NOTE: Read Instructions before completing this form.
<br />"'W 1-7 11
<br />NQ
<br />FREQUENCY
<br />SAMPLE
<br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION • OF
<br /> EX TYPE
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ANALYSIS
<br /> SAMPLE x 1?? ;•4 ,. *x.sz•:i t A 1 Lc f
<br /> MEASUREMENT
<br /> PERMIT fi ;
<br />? ::
<br />+r * : # "•->p',#
<br /> .t .
<br />. .
<br />
<br />REQUIREMENT ILL
<br />
<br />r _ SAMPLE :. ,•? :. t.. t x?r .. A.
<br />#
<br />"
<br />" MEASUREMENT
<br />t y
<br />H l?y,„y4
<br />Y 'a ?,J > `:
<br />"
<br /> PERMIT ,. r?•.< d••:?•:, e..? ?r•t+• E t'+• ?,;;y.a_ _ t
<br />}`•;• '.'ir
<br />-. .'"1 ?.. .r.,l
<br />v .
<br />K. p..
<br /> REQUIREMENT _b ?t fz4de' era h~ pJ urT?1`^ t?t
<br /> SAMPLE
<br />.,Icr:.
<br />;?•:x
<br />.. :2 • ti:.'•
<br />_ t z
<br /> MEASUREMENT
<br /> PERMIT
<br />.°.
<br />t `:... „- ., m'
<br />.='••
<br />:`° 1 .K :•0`4.: K)"o°`' ?? ' a, v?
<br />
<br />
<br />" REQUIREMENT
<br />„
<br />Hip
<br />,
<br />C
<br />i L
<br />SAMPLE
<br />:' d;
<br />, .':.::. a
<br />rr -, :
<br />w ..• s. A :.i
<br />+ r
<br />.-w
<br />.
<br />. .. MEASUREMENT
<br />.; ? (
<br />,'
<br />`
<br />* PERMIT •,. r#:r i> ., :f :.... .:?• .. ,..,... ;' .. ':r ... >.:I ?'. ;'31' c '. ''?':
<br />{
<br />.
<br />e,a'
<br />a n^
<br />•.: REQUIREMENT
<br />
<br />6t
<br />` '3
<br />` s
<br />'
<br />J
<br />" SAMPLE
<br />.'
<br />a
<br />t
<br />,
<br />s w r MEASUREMENT
<br /> PERMIT t' fr'
<br />? .>• .?
<br />, # t, 3+;??r tv i?Y s?.'
<br />t?
<br />t
<br />' . t ; r .. .,
<br />k
<br />. t
<br />?..i . .
<br /> REQUIREMENT ,
<br /> r ra
<br /> SAMPLE .., ..,.; w s .... ,+.. rr. .. i?sa!' m s1,• :'.- - t. ?'
<br />' MEASUREMENT
<br />x .t k k a.,??_.fH' •' r
<br />: ,
<br />PERMIT
<br />
<br />•
<br />
<br />,. ?
<br />
<br />{
<br />
<br />k
<br />
<br />
<br />p ,•,
<br />t 1
<br /> REQUIREMENT
<br />,? c a SAMPLE i::•. V c4{,u ;s m :. .. g} ;.s; t:t: 5: .. ,.
<br />r r MEASUREMENT
<br />kl$
<br />F
<br />.-.
<br />,? PERMIT
<br />ks
<br />s... s.
<br />:;°#
<br />rr;<<
<br />{ ( t
<br />_ ', 41"4v$
<br />` REQUIREMENT .
<br />a
<br />
<br />?iAMEJTITLE PRINCIPAL EXECUTIVE OFFICER I certify under penalty of law that this document and all attachments were TELEPHONE DATE
<br /> preprd under my direction or supervision in accordance with a system designed
<br />-
<br />-
<br />y{,
<br />x that qualified personnel properly gather and evaluate the information
<br />to ass
<br />m --_.---
<br />?d? 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 />.,?c TM?.°st.*.e submitted is, to the best of my knowledge and belief, true, accurate, and complete.
<br />IGNATURE OF PRINCIPAL EXECUTIVE
<br /> 1 am aware that there are significant penalties for submitting false information,
<br /> violations
<br />t f
<br />k
<br />i
<br />d i
<br />i
<br />i
<br />i
<br />i
<br />f fi OFFICER OR AUTHORIZED AGENT NUMBER YEAR MO DAY
<br />TYPED OR PRINTED .
<br />or
<br />now
<br />ng
<br />mpr
<br />sonmen
<br />ty o
<br />ne an
<br />including the poss
<br />b
<br />l CODE
<br />COMMENTS AND EXPLANAIIUN Ur ANY VIULAIIUIVa Irfererence au arracnmenrw fiert:j
<br />?iC f ._ 'k `1 f._, ?'_ .et`'iwlt .'tt +.i-< 'EtcYa r''• .utt ta,...
<br /> :b
<br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used.
<br />
<br />t ti;,. -4 , ThzS.a.4 ptS)1117. PAGE
<br />.? r t -..
<br />
|