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PERMITTEE NAME/ADDRESS (IncludeFaciliryName/Location ifDierent) <br />NAME r <br />s <br />ADDRESS F .'i-j , r. t. ,. I N. f7 <br />FACILITY . <br />LOCATIONt„ r ` 'A <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) - Form Approved. T <br />DISCHARGE MONITORING REPORT (DMR) ,( N;I ;;•; OMB No. 2040-0004 <br />'I <br />PERMIT NUMBER DISCHARGE NUMBER " F <br />r t : r> <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY- <br />FROM <br /> ..v.r. .a-- aaI a.aavlla YCIV IC {4VI IIPICLIIIU VII , IVI111. <br />PARAMETER UANTITY OR LOADING QUALITY OR C"ONCENTRATION NO. FREQUENCY SAMPLE <br /> OF <br /> AVERA E MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE <br /> <br />SAMPLE <br />? ,:..i,...?. <br />.. .... .. ::. .: v "... <br />, <br />-777 <br /> <br />__ . <br />a, `? ((• !.%'t J.yw.; Ty MEASUREMENT <br /> t <br />- <br />? <br /># <br />t <br />' <br /> PERMIT . . <br />. : t <br />< <br />fi i Dr .' i* i ? S .. t5 ..- : A } t Yt ! <br /> <br />11^ T i <br /> REQUIREMENT <br />• ? <br />.r . _. ,. .. .e ... <br />.... <br />SAMPLE <br />Ord: ?..r:. <br />...:. _.. <br />n <br />., . .. ,. <br />r.,_' <br /> MEASUREMENT - <br />. <br />PERMIT <br />.1 1)Q <br />r; <br />I <br />,.._?t I>'-?n <br />Q <br />REQUIREMENT <br />'= - <br />VAL I <br />I <br /> L <br /> SAMPLE + - x Y s. .. ._ .... t? <br />;.t< :, r'•"'`?N. 4.., " MEASUREMENT <br /> h r <br /># <br /> PERMIT . T, 7 <br />f_t''? 1. W 1 i::.. REQUIREMENT -1a - r <br /> SAMPLE :. ?? ., „ . ... r;._' ' <br />` %'? ' ` i. ' _' '. =__ •_ MEASUREMENT <br /> k t t .M F - 7- - <br /> PERMIT . r r s 5 'i. s i <br />7 .. 1 <br />17 T7 7 T 1-171t <br /> REQUIREMENT 1 ti l t+rr s__' ` F <br /> <br /> SAMPLE t . .y . t- 7"777T 7 <br />i,^ MEASUREMENT <br /> *` ? t€• • . <br />: <br /> PERMIT , <br />- r r•? ? 3 .. <br />..: . <br />-? .. ,._., <br />1€ .: s t t c? ._ ?...?.,?'`?,• REQUIREMENT <br />' SAMPLE ? •• 7 r._I,a • <br /> MEASUREMENT <br /> <br />' <br />z•1E•.;,. <br />s <br />,_ <br />f 4 :,. <br />• <br /> PERMIT : <br />' , .: <br />? :..- ? ' z. F_, ; _ ? „ ... v <br /> REQUIREMENT <br /> SAMPLE a ,. -... 1 .. `• <br />r. _ ,_ <br />- i , t: ;: ,: -: • ;.:i"t:?'":'Six' MEASUREMENT <br /> <br /> PERMIT fl. At t.,. - ... ;f .. „'a- n'F;` t,31f" :i PL_ r •?-`fi,ri_._..? <br /> REQUIREMENT s. .: _ <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certify under penalty, of law that this document and all attachments were T ELEPH <br /> <br />prepared under my direction or supervision in accordance with a system designed ON E DA TE <br />I", `LJ -• /i ! ,' J + ?- <br />P ?, , ,? , to assure that qualified personnel <br />q properly gather and evaluate the information <br />submitted. Based on my inquiry of the person or persons who mana <br />e the s <br />stem <br /> <br /> <br />r, <br />- f g <br />y <br />, <br />or those persons directly responsible for gathering the information, the information <br /> <br />I <br /> <br />- • <br /> <br />? <br />7, , j 'ic j, l -i ! r submitted is, to the, best of my knowledge and belief, true, accurate, and complete. <br />I <br />SIGNATURE OF PRINCIPAL EXECUTIVE r I , : c fr", <br /> am aware that there are significant penalties for submitting false information, <br />TYPED OR PRINTED including the possibility of fine and imprisonment for knowing violations. OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />M <br /> <br />r-nMMFNTS ANTI FYPI ANATInN nF ANY WIN <br />ATInNC /Des-. - CODE O DAY <br />7li <br />..t, a ...EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. - T'h1Y1S-a 4=park'fOrm. PAGE a OF <br />t,_,