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PERMITTEE NAME/ADDRESS (Include Facility Name/Location if Different) <br />NAME S' t{ h{'y1t ^i, ^el:.. t %*""- n <br />ADDRESS !" :q <br />':t: r., <br />FACILITY <br />LOCATION <br />C I-, <br />Form Approved. <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) OMB No. 2040.0004 <br />DISCHARGE MONITORING REPORT (fDMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />:?•i .- .^r^ ,t V Fall <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO• DAY, <br />FROM - TO .. _. _ w <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. <br /> <br />EX FREQUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE *-.k**** r- .'-. 1!- z '? <br />®' s <br />0. 5 i 3 <br />? I <br /> MEASUREMENT <br />} t r.? PERMIT r. s <br /> REQUIREMENT' ::•?:.= mot'' lr! f <br />4 <br />k <br />' SAMPLE <br />.. <br /> <br />4 S.o <br /> <br />?M I <br /> <br />180 <br />i-{) <br />r.:• MEASUREMENT <br /> <br />PERMIT 4' 4? <br />?). `REQUIREMENT <br />t tit >=:._! 't SAMPLE A <br />4- It <br />} <br />_•'.;,, . i_ ' MEASUREMENT <br /> PERMIT <br /> REQUIREMENT ,. <br /> <br />e..t t t = f ; .# <br />i-D <br />SAMPLE <br /> <br />G. C)5 <br /> <br />Q? <br /> <br />IAac, <br /> <br />6 P-A <br /> MEASUREMENT <br />t_,• ,. L PERMIT .. , . - <br /> REQUIREMENT <br />:.:..: <br />L,•^t _ 4I <br />SAMPLE .. r.M1si ??;i:.. '.: ._: <br />CJ <br />Jt-' coy. <br />`' <br />I/) e <br />IGOE <br /> MEASUREMENT ? <br />lti rt _.f , r1 PERMIT a 1 h :; `r . ! _ :.i+ <br /> REQUIREMENT a" i; ?}rs`9 it=r <br />e .mil t 3 SAMPLE '. <br />M r. <br /> <br /> <br />.2 <br /> <br /> <br />.2 <br />s <br /> <br />t0i <br />?E s <br />,"Ur MEASUREMENT <br /> <br /># <br />4,1 <br />PERMIT <br />t. REQUIREMENT ilL <br /># f ' } t rte, ; > +, SAMPLE x,. y n-?t aN ;: •k -< 1 z . <br /> <br />< ?. 5 <br /> <br />< C). _ 1I <br /> <br />I <br />A- T2 <br />f1 MEASUREMENT <br /> PERMIT s.lr .. ' w...i i 17 <br />:. <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certify under penalty of law that this document and all attachments were <br /> <br />d <br />d <br />i <br />d <br />th <br />t <br />d <br />d <br />di <br />i <br />r <br /> <br />TELEPHONE <br /> <br />DATE <br /> un <br />er my <br />on or supervision <br />n accor <br />ance wi <br />a sys <br />em <br />esigne <br />prepare <br />rect <br />to assure that qualified personnel properly gather and evaluate the information 1( <br /> submitted. Based on my inquiry of the person or persons who manage the system, <br />or those persons directly responsible for gathering the information, the information <br />QL <br />t t\ <br />) <br />' <br />{ <br /> <br />/ ?- <br />submitted is, to the best of my knowledge and belief, true, accurate, and complete. <br />I <br />h <br />h <br />l <br />i <br />f <br />i <br />i <br />f <br />l <br />i <br />f <br />i <br />ifi <br /> <br />SIGNATURE OF PRINCIPAL EXECUTIVE ? <br />3 <br />l V 1 ?( <br />l 4J / <br />? <br />?, <br />V O? <br />TYPED OR PRINTED am aware t <br />at t <br />cant pena <br />t <br />es <br />or subm <br />tt <br />ng <br />a <br />se <br />n <br />ormat <br />on, <br />ere are sign <br />including the possibility of fine and imprisonment for knowing violations. OFFICER OR AUTHORIZED AGENT AREA <br />CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attacnments here) <br />1 <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. ` :• MiFis"'a *4 - arm. PAGE gOF