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PERMITTEE NAME/ADDRESS (Include Facility Name/Location if Different) <br />NAME <br />ADDRESS p <br />FACILITY <br />LOCATIONS' i a 1 L I` -` r <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 />NOTE: Read Instructions before completing this form. <br /> NO FREQUENCY SAMPLE <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION . <br />EX OF <br />LYSIS <br />TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ANA <br /> <br />SAMPLE n s >i <br />r. <br /> <br />? <br /> MEASUREMENT t : a 9 i+' 'sA <br /> ' S F4n <br /> PERMIT # s i :f 473.77 ?'o x 6. 5 S," '77 <br />Y n 3 -. <br />' <br /> _0 0 1 <br />r <br />F ! L.LI y : rc .. _. _ ^1?. Jx REQUIREMENT <br />w7.? SAMPLE •.r -fi -'i" ., 'ii. t ., <br />' <br />NID <br />t" V9Ft MEASUREMENT <br />3. <br />. <br />. Yr'- <br />b s <br />00 PERMIT at• -s? # ' x ?# r _.. t a 4 .* a 3Ft 3 Mt .. <br /> AV 1) AI s_-` MA <br />- ... .._, <br />??'?t i °t <br />L iL..°' REQUIREMENT <br />ri li _ !. _:! +1 ) SAMPLE <br /> MEASUREMENT ?` ?.j • ?-' <br /> Et C: yi' ( , <br />C? Q 'S 3 RMIT n 3 A •ir „ k x ? st ?t = .e <br /> PE <br />k.iI REQUIREMENT <br /> SAMPLE <br />s' <br />? <br />: <br />TO AL ter ? <br />F MEASUREMENT <br />. <br />. <br />. <br />_ <br />ta' C? i r PERMIT QQ a .v". z t1 ° t t ? <br />F r L 1 t F'4 i V r .. _.. `? L.4I REQUIREMENT x D°s? :? V ?` <br />401 <br />0U SAMPLE <br />' d <br />.. MEASUREMENT i ....- <br /> #r ;#ari? sI ?I rE a r f »# f w ?# drxr sr tr a . to <br />0:3 PERMIT ; ? € r <br />Lt rz tv'i <br />EF•r f_UP t ?S `E,t?.i REQUIREMENT " Q <br />M, -...... .. . <br />1_rta., s <br /> <br />01 t,\ •T P: <br />!E',,'T <br />AW <br />F kJ 'r R <br />TH <br />SAMPLE <br /> <br />MEASUREMENT <br /> <br />.^s <br /> <br /> <br />tJ <br />? 9 x s .. r > r .? a <br /> <br />i <br /> <br /> <br />? <br /> <br />C <br />_ <br />I <br />J -E F <br />a ? PERMIT "r Q <br />i IF )i <br /> <br /> <br />] F (tl ) I r :.a `MF}rti..i.J_E <br /> <br />REQUIREMENT <br />fir' <br />'300 t <br />' G I_. <br />M <br /> <br /> <br />t "L <br />i 7i "tsi <br /> <br />SAMPLE <br />MEASUREMENT <br /> <br />P? . 0 .s. } <br />, I f <br />-" <br />0' PERMIT <br />t r. _ <br />r r{.? w <br />4 <br />°t ?.tJ id } P,' . L; `J,?rl._ i_1f REQUIREMENT L.7 { r"?V i`) i) `? <br />TITLE PRINCIPAL EXECUTIVE OFFICER <br />E I certify under penalty of law that this document and all attachments were TELEPHONE DATE <br />/ <br />NAM direction or supervision in accordance with a system designed <br />ared under m <br />re <br /> y <br />p <br />p <br />to assure that qualified personnel properly gather and evaluate the information R <br /> submitted. Based on my inquiry of the person or persons who manage the system, <br />the information <br />the information <br />th <br />i <br />ibl <br />f <br />l <br />O <br /> , <br />or ga <br />er <br />ng <br />y respons <br />e <br />or those persons direct <br /> submitted is, to the best of my knowledge and belief, true, accurate, and complete. $IGNAT RE OF PRINCIPAL EXECUTIVE <br /> I am aware that there are significant penalties for submitting false information, OFFI ER OR AUTHORIZED AGENT AREA <br /> <br />TYPED OR PRINTED <br />including the possibility of fine and imprisonment for knowing violations. <br />CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLAI wns Irrererence an audc;nmerrw nerej <br />t, ..rr 1??? C E:? r Ft 10-'i'fs?, 44 HR PREr.IP F:Vf'.s` T It te,JE,:'' ?' T01 I:dU PEN 0 s"'H 0( IF R E0I ja RE..'?tulENTS 11,4 <br />_.._ 1 .. <br />..?.A SHALL. Dr r..iJt .r•, f t H, <br />PART T. f ANY ??I?3I?. 14r?T_ i)? :=. -' ' ,...:.i <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. C,;,)c1155 : [jEFINS tS£a°44ja4'fo m. PAGE 1 OF