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PERMITTEE NAME/ADDRESS (Include Facility Name/Location if Different) <br />NAME ` <br />ADDRESS r,tt:,. 1 <br />FACILITY <br />LOCATION (, 1 <br />Form Approved. <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES) OMB No. 2040-0004 <br />DISCHARGE MONITORING REPORT (D R) <br />k,'r ? ?fti <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO NOTE: Read Instructions b <br />efortecofflpleting this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT F 3f k f s.c ' s 4•" 'r°:c _ 3..e <br /> REQUIREMENT <br />t . c SAMPLE -t : .i..1.. ?•; I ! ,g. ,.># <br />NDi E <br />^"rl E- MEASUREMENT <br />. <br />r 1 PERMIT 3?#,i### sf s t a i s t ,:+ ' ?- k?. l" ...Z; <br /> REQUIREMENT y <br /> SAMPLE -r c F :, o i .- <br />; rB1 E MEASUREMENT <br /> PERMIT P I`II'll f r I:=, t ,?_'jM? 0'3 <br />t r+l 1 CF? r" as : • . ). REQUIREMENT Y t <br />F ^.t SAMPLE r <br />7 , MEASUREMENT <br /> PERMIT <br />r <br /> <br />i <br /> <br />l <br />1311 <br />'71R sb V46._.? _f; REQUIREMENT: <br />V v: , <br /> <br /> SAMPLE s { ... ;t. _ ,. <br /> MEASUREMENT <br /> PERMIT ;. <br />00 35 <br />n°41 E p. 1 > J,:L..t? REQUIREMENT <br /> SAMPLE <br />,a. <br />a ., . . <br /> MEASUREMENT <br /> PERMIT t?aKf ? x.. r.L s" , ) <br />' 3 .., r,. REQUIREMENT S I <br />i.. SAMPLE <br /> MEASUREMENT <br />_ PERMIT <br /> REQUIREMENT' , <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certify under penalty of law that this document and all attachments were !?' q TELEPHONE DATE <br /> <br />7 <br />'? ?f•'?t"?' /LJ I'°? prepared under my direction or supervision in accordance with a system designed <br />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, `a } <br /> or those persons directly responsible for gathering the information, the information ..?/ i <br /> <br />'? # r submitted is, to the best of my knowledge and belief, true, accurate, and complete. <br />SIGNATURE OF PRINCIPAL EXECUTI <br />1 <br /> I am aware that there are significant penalties for submitting false information, <br />TYPED OR PRIN ED including the possibility of fine and imprisonment for knowing violations. OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLA I TUNS (Hererence an arracnmenrs nerej <br />t. .. - Z, e qq as v . n.". .. <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. v a PAGE OF