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PERMITTEE NAMEIADDRESS (include FanGty NamelLocation if Different) <br />NAME <br />ADDRESS is T',?+i^ <br />FACILITY <br />LOCATION r <br />Form Approved. <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ? [(NPDES) OMB No. 2040-0004 <br />DISCHARGE MONITORING REPORT (DMR) ,, r• r,> <br />PERMIT NUMBER DISCHARGE NUMBER Y F . ?'.1"AL. ?; OBI` 1 <br />i I-: :'f t y? ? ._.. ; t:.:;•, r:, .,..; ;0. ,;,. <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO D Y ~• <br />FROM I ' I I I TU 5,! I rr. I - i i I is +.L d .....• , ti ii a .., } s <br />L NOTE- Read Ingtrurtlnnc hafnrn emmnlafinn fhic form <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY SAMPLE <br /> OF <br /> <br />AVERAGE <br />MAXIMUM <br />UNITS <br />MINIMUM <br />AVERAGE-•_ <br />MAXIMUM <br />UNITS EX ANALYSIS TYPE <br />t + `? r SAMPLE <br />MEA , 'r o- K• :t <br />t :.: ; ..., r .. :• C.1 <br />S <br />5 <br />?S a 7 t 3 t <br />I/)a <br />Q <br />? <br /> SUREMENT . . V - <br />71 .-? , <br />PERMIT <br />x;.?.i.,, :r• <br />??. r <br />...< <br />_ - <br />Pl,a <br /> REQUIREMENT' <br />1 y.. • t- t <br />•- •- <br />SAMPLE ...i .i"#' :i'S:- . i' ., .. 4; -... . yi•'h .. t <br /> <br />I <br /> <br />a. _ . MEASUREMENT Q. 44 <br /> PERMIT <br />„Y <br />t''° l;r! ,• 'tEI i t * l_.. +; REQUIREMENT V .... ???^' .. <br />r l . I i. SAMPLE :r :3 . :,, :1•:, ,- . 3 . ...... <br />r <br />C f:"_+ :: • MEASUREMENT Q• 2. !e ?. ?. W <br />71 } <br />fl': r <br />PERMIT <br /> REQUIREMENT C <br /> SAMPLE <br /> <br />MEASUREM .. -: -?-i.?••i!•'.: ... r ?-•s? •t't'ik• .v •''t ....., <br /> <br />L to <br />S <br />40 <br />S r' .. <br /> <br />If 1 <br /> ENT . . <br />'... . PERMIT a .. , . f ... <br />l r• •t,G3 .'? REQUIREMENT s .. R F <br /> SAMPLE <br />r <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE t <br />, <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER 1 certify under penalty of law that this document and all attachments were <br />I <br /> <br />TELEPHON <br /> <br />E <br /> <br />DATE <br />•••'''.??? <br />W ' prepared under my direction or supervision in accordance with a system designed <br />to assure that qualified personnel properly gather and evaluate the information <br /> <br />r <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 /> <br />a L,`? t•.!C <br />,QS? ty, <br />\\\ <br />submitted is, to the best of my knowledge and belief, true, accurate, and complete. <br />1 am aware th <br />t th <br />i <br />ifi <br />t <br />l <br />i <br />f <br /> <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />(?? <br />v /?,ll.? ? <br />iiii ddddV P. V <br />r IOL,/ <br />f /? <br />l 4?1 p 1 <br />?ry <br />V <br />TYPED OR PRINTED a <br />ere are s <br />gn <br />can <br />pena <br />t <br />es <br />or submitting false information, <br />including the possibility of fine and imprisonment for knowing violations. OFFICER OR AUTHORIZED AGENT _ <br />AREA NUMBER YEAR MO DAY <br />n?uua-urc. wura a-vm wwu r.rvwi ?r• w...?... ?. wr....... ...-?_--_-- -.. _..- CODE <br />..? r..... -... _.,...?..?.. ... .-.... ....._........v l..`. c. c..a.c au aaaaaa.nuac.aaa naza c? <br /> <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. u4f?}? ; " ,t j3hjga1 id 4-tlii f rm. PAGE