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PERMITTEE NAME/ADDRESS (Include Facility Name/LocationifDiiferent) <br />NAME <br />ADDRESS`) <br />. t ; <br />FACILITY <br />i LOCATION I-It'd T, r <br />f <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY. I YEAR MO DAY. <br />FROM .. TO <br />Form Approved. <br />OMB No. 2040-0004 <br /> <br />toy'. <br />3`' `, ' to f4 r A <br />NOTE. Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION Np, <br /> <br />EX FREQUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ANALYSIS <br /> <br />! t4_.. r3`l , _ :.. <br />SAMPLE r ) .ry <br />VISUAL MEASUREMENT ' <br />3'4{'f tf <br />.41 :L..i..?I' PERMIT <br />REQUIREMENT .sc k:ktt F -7 i Y <br />? A i. T. a <br />.. <br />x..i <br />Itir ti t <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 />AME/TITLE PRINCIPAL EXECUTIVE OFFICER I certify under penalty of law that this document and all attachments were TELEPHO NE DATE <br />N 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 />rin <br />f <br />th <br />ibl <br />i <br />l <br />f-- <br />-p <br />?`? <br />r <br /> , <br />g <br />or ga <br />e <br />y respons <br />e <br />rect <br />or those persons d <br />submitted is, to the best of my knowledge and belief, true, accurate, and complete. SIGNAT RE OF PRINCIPAL EXECUTIVE 0 t <br />t <br />1 <br /> I am aware that there are significant penalties for submitting false information, FI R OR AUTHORIZED AGENT AREA <br />TYPED OR PRINTED including the possibility of fine and imprisonment for knowing violations. OF CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference aU attachments here) <br />CIR :ct3 YR C-114 HR FRECIP <br />t_ <br />PAR t . B ANY A, .1. 1, 0i li :.... t_ r i r, 'r+ ??. ? b. x.. . t':_I F L. _. 47 !J <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used <br />EVENT TO s ; ?+ > 1' J ' h? '... Fc x_: ??'JT FU INF N T S z I *I <br />..? . <br />" THE D I tr'' i two t EN W I TH T Ni H-i'.j.. ._:. <br />cto 56t 09LV70M 4V0*]form. PAUL 2