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PERMITTEE NAME/ADDRESS (Include Facility Name/Location if Different) <br />NAME I - swr rq <br />ADDRESS r) L' .J.. <br />rJ" 3 Iw <br />FACILITY .., <br />LOdATION a <br />yC t <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES Form Approved. <br />DISCHARGE MONITORING REPORT (DMR) ) OMB No. 2040-0004 <br />i i ,F <br />PERMIT NUMBER DISCHARGE NUMBER t r ?I <br />MONITORING PERIOD <br />O DAY <br />YEAR YEAR MO DAY <br />FROM M +\ TO <br />„ NOTE. Read Instructions before co pleting this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO• FREQUENCY SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />I , SAMPLE .. -r' r: •?,. .. ... -. ..... ,,... :. .. _ ",' , <br />711,3 .1 ,( t.? MEASUREMENT <br /> PERMIT s :•;•."q. .k #>..:...ir?, ;<i# ##?n ;_', :•u3 t = 1',rS.. <br />'= 1 1`:(4 -, REQUIREMENT <br />a .. s ;;. SAMPLE k i • ,. .. .. M' a <br /> MEASUREMENT <br />„• . ._i :' <br />i PERMIT 4 0 ! <br />r s • <br />17-JNIT G' :it <br /> <br />REQUIREMENT <br /> <br /> <br />'`3 ?T <br />:0 1 y <br /> <br /> <br />.X"a `? :'Ate <br /> <br /> <br />• <br />... -: C3 } SAMPLE ; .r _ . . <br />TOTAL MEASUREMENT <br /> PERMIT f 3t' :•;. . s d3 # i? ;K # it s 1 w .' SF , CJ `fit" t? <br />;1.:s ,5 VAI.-; REQUIREMENT <br />;5... A1,15 SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />Y <br />. <br /> <br />?? . _L. .. ask a? I 'a' I REQUIREMENT i <br />'{ f `:• <br />t.. ,. 1/`'.i ??:''t°` r <br />..,. {._ :..k. <br /> SAMPLE { .• tF i .. 1 .: :•3# it <br /> MEASUREMENT <br />_ . , .. Y. PERMIT ?. ;s= , # •• 1 # 7 ; C` `t <br />t <br />`!3 "J.LIG. REQUIREMENT - r s r. t <br /> SAMPLE s z 4 <br />-, •r _c gl ) MEASUREMENT <br /> PERMIT <br />v _ I <br /> <br /> <br />?,F ( i p' t 1 <br />"i "'? R 4 <br />F\,Svyc.J REQUIREMENT <br />14. <br />why Y <br />f l SAMPLE , ?f -j. •:: <br />>.a. . ._ . <br />,,E•M kN;P1 A ;u0D R MEASUREMENT <br /> <br />l 1 t rt c r, ! REQUIREMENT 7 <br /> <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER 1 certify under penalty of law that this document and all attachments were <br />di <br />e <br />i <br />i <br />i <br />d <br />ith <br />t <br />d <br />i <br />d <br />d <br />d <br />ti <br />7 .•' <br />TELEPHONE <br />DATE <br /> prepare <br />er my <br />r <br />c <br />on or superv <br />s <br />on <br />n accor <br />ance w <br />a sys <br />em <br />es <br />gne <br />un <br /> <br /> <br />? F Al A TO, <br />If <br />? to assure that qualified personnel properly gather and evaluate the information <br />submitted. Rased on my inquiry of the person or persons who manage the system, <br />` <br />• or those persons directly rCSpomible for gathering the information, the information v • --- <br />v <br />~ ? to the best of my knowledge and belief <br />true <br />accurate <br />and complete. <br />submitted is % <br />7' <br />4 t <br />t "? I .e , <br />, <br />, <br />, <br />r <br />ifi <br />lti <br />r submittin <br />rmati <br />n <br />I <br />t th <br />i <br />t <br />f <br />f <br />l <br />i <br />f <br />th SIGNATURE OF PRINCIPAL EXECUTIVE , <br />- <br />?- U t <br /> , <br />a <br />ere a <br />e s <br />gn <br />can <br />pena <br />es <br />o <br />g <br />a <br />se <br />n <br />o <br />o <br />am aware <br />OFFICER OR AUTHORIZED AGENT <br />AREA <br />TYPED OR PRI TED including the possibility of tine and imprisonment for knowing violations. CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIULATIUN5 (Rererence an artacnments nere) <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. <br /> <br />s: a -4-part-form. N <br />PAGE OF <br />