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PERMITTEE NAME/ADDRESS (Include FactlUy Name/Location if Different) <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />7 <br />R' <br />? i k ? t 1 .k'° _..-l e _14t •:.J\'A?jl-> .I } ..._Y <br />Form Approved. <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES) OMB No. 2040-0004 <br />DISCHARGE MONITORING REPORT (D R) «p <br />PERMIT NUMBER DISCHARGE NUMBER 0; !7_ -T <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO. DAY " <br />FROM TO a}?. r.:? i'i? '1k w4•,'ir': ?t, ; i''• `. <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE , . MAXIMUM UNITS <br />I # ? SAMPLE tt } : b1l7.'.K h <br />Z 7, i? <br /> <br />/ <br />' <br />? <br />f i <br />, <br />= <br />' <br />• MEASUREMENT -.r 40. ®. ? ' <br />., <br />: <br />......... <br />i <br />...., , <br />?.. <br />.. <br /> PERMIT - . <br />-r <br />- " <br /> REQUIREMENT :? - 'i ttE'. . <br />} r <br />' <br />' SAMPLE <br />l 4 <br />)?- <br />'480 <br />j. <br />w . .t ! •,_. <br />._r MEASUREMENT . <br /> <br />CIA 2-, <br /> <br />PERMIT > L <br /> REQUIREMENT ;. <br />-.- r ".. <br /> SAMPLE <br /> MEASUREMENT <br />. _, ...., PERMIT ! . , , .. .. 1' <br /> REQUIREMENT <br />tj*";3u SAMPLE <br />` <br /> MEASUREMENT I <br /> <br /> <br />4 4.: <br />r ( ) <br />f <br /> <br />PERMIT <br />=:: . <br />?e=3'? L".{??T .,i"i?•?;"..+ 'J•ii,.U .:REQUIREMENT. -".'Irzi' ... .. .', _._ .. it..'..'[.. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certify under penalty of law that this document and all attachments were <br />re <br />ared under m <br />r su <br />ervision in accordance with a s <br />di <br />stem desi <br />ned <br />ti TELEPHONE DATE <br /> p <br />p <br />y <br />p <br />rec <br />on o <br />y <br />g <br />to assure that qualified personnel properly gather and evaluate the information _ <br />? - <br />i submitted. Based on my idquiry of the person or persons who manage the system, <br />??? <br />? <br />} or those persons directly responsible for gathering the information, the inforanon cl' ,y f <br /> submitted is <br />to the best of my knowledge and belief <br />true <br />accurate <br />and complete. 30? <br />`j 430 <br />6 <br />10 <br /> <br />V , <br />, <br />, <br />, <br />I <br />th <br />t <br />lti <br />t th <br />if <br />f <br />itti <br />f <br />l <br />i <br />f <br />ti <br />i <br />b SIGNATURE OF PRINCIPAL EXECUTIVE 1 r <br /> <br />TYPED OR PRINTED am aware <br />ican <br />pena <br />a <br />ere are s <br />gn <br />es <br />or su <br />m <br />ng <br />a <br />se <br />n <br />orma <br />on, <br />including the possibility of fine and imprisonment for knowing violations. <br />OFFICER OR AUTHORIZED AGENT AREA <br />CODE <br />NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND LXPLANATION UF,ANY VIULAI IUNS (Keterence all attacnments nere) <br />a <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used.. c:r ' {d1s lsa 4-ht?it+fOrnl. PAGE roF