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PERMITTEE NAME/ADDRESS (Include FacilityName/Location if Different) <br />NAME <br />1 <br />ADDRESS H`i 1 rat d` l; 4 { E+ , f? ° l.. <br />?.f'Tt ,]:ii li't? JIt?, j??•"T+•-._ -r ., ..-._ . <br />FACILITY e.: n <br />LOCATION <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY_ <br />FROM TO <br />Form Approved. .. <br />OMB No. 2040-0004 <br />!vf F. t-A ((-- <br />i+ <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. <br /> <br />EX FREQUENCY <br />OF <br />YS <br />S SAMPLE <br /> <br />TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ANAL <br />I <br />OIL. AN` r SAMPLE .r .< •s-. •sr .. '`"y z . ?: ..?; :... 3 • . ; e } ,,,. <br />?Jf t+.? <br />V I Sl <br />AL MEASUREMENT <br />.. <br />. ^ t t L <br />L <br />! <br />C <br />+ x ; i . . <br />T,° `r` '! F - L..!.1?': <br />., f T- 1. ... tta._ lax .. .. Ct " ,r . <br />F PERMIT <br />REQUIREMENT s i :: 3# §r ''R T? <br />MAY <br />.« a ,- - <br /> <br />, .. ,.. <br />.., . _. # k ? ?r i tt y •9>, t? ?r f # # -"... . <br />. <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certify under penalty of law that this document and all attachments were TELEPHONE DATE <br /> direction or supervision in accordance with a system designed <br />ared under m <br />r <br /> y <br />p <br />ep <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, <br />the information <br />the information <br />atherin <br />f <br />r <br />ibl <br />di <br />tl <br />?..,, <br /> , <br />g <br />g <br />y respons <br />e <br />o <br />rec <br />or those persons <br />submitted is, to the best of my knowledge and belief, true, actuate, and complete. SIGN URE OF PRINCIPAL EXECUTIVE <br /> I am aware that there are significant penalties for submitting false information, O ICER OR AUTHORIZED AGENT AREA <br />TYPED OR PRINTED including the possibility of fine and imprisonment for knowing violations. CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANAI IUN Ul- ANY VIULAI IUNO nererence an ataafilial w rrcrvl <br />?',?IF' ?''?'F?t•.l?C 5,1..1 :IF 4.:1 T! • 1'"iL.l"2t?1..IL I]S PROOF ? ?'OOF' ' E•.':=(•??!: G=4s IN <br />t. WAV,)ET. MR R 10-YR, HR F'R_t I.... ?f?,.l a?:NTS N <br />PART J:..'. ANY EL.DDI FI 1',IAi._ r)AYA '.:... -1-kJ t_a."..-E 70 L'1k `_.:tl;)N V!S 4+iIN 4E: t <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. ?(#UPI'411riI1, PAGE 2 OF