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r <br />PERMITTEE NAME/ADDRESS (Include Facility Name/Location if Different) <br />NAME 1''!. " 111 1 1 CAL, MIN 71 NG <br />ADDRESS <br />i. ,. __._ _. _. r... 6 % .... Wa I' <br />-? n <br />FACILITY L;, r) t,,, <br />LOCATION i il,vJ <br />Form Approved. <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) OMB No. 2040-0004 <br />DISCHARGE MONITORING REPORT (DMR) MINOR <br />i <br />(S;Jl.3P J C <br />PERMIT NUMBER DISCHARGE NUMBER 3.I?+i • R`)' I <br />Gi ireE s"xt:'r Fri:;Ni i' ± 3 t C{7?i 't ±+E' ?' K <br />MONITORING PERIOD <br />. <br />YEAR O. DA YEAR MO- DAY <br />FROM .t TO .. #3 .M NO i? S SCH?3RG- } _. ? `' tr ! <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION Np, FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE' MAXIMUM UNITS <br />r`''; Tr q SAMPLE 43F 1? V ? SvA <br />V I SUAI..- MEASUREMENT <br />8 4'06 w 7 PERMIT f E"P ` ' , j ;r } =: t a 3t r xr F# # 1 <br />T <br />PAL <br />i ? t <br />tw'A[_L)F REQUIREMENT I i°dS Mec;X i i--0 ?#F3ti ? MQN T H <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT , <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT` <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />' <br /> REQUIREMENT <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/FITLE,PRINCIPAL EXE UTIVE OFFICER I certify under penalty of.law that this document and all attachments were TELEPHONE DATE <br /> prepared under my direction or supervision in accordance with a system designed ; <br />%) 3 - to assure that qualified personnel properly gather and evaluate the information L? <br /> submitted. Based on my inquiry of the person or persons who manage the system, <br />res ponsible for gathering the information, the. information <br />or those persons directly <br />17 C <br /> <br />e C]Tl1"7" <br />V L S" . <br />submitted is, to the best of my knowledge and belief, true, accurate, and complete. <br /> <br />' <br /> <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />t/? ? <br />V"'1 `i'rJ1Y5' <br /> <br />TYPED OR PRINTED significant penalties for submitting false information, <br />I am aware that there are <br />including the possibility of fine and and imprisonment for knowing violations. <br />.. AGENT <br />OFFICER OR AUTHORIZED AREA <br /> <br />CODE <br /> <br />NUMBER <br /> <br />YEAR <br /> <br />MO <br /> <br />DAY <br />( Fi <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Referencetafl attachments here) <br />T E-..i ?1 . 1fILI BE t??t?IVE-:D FOR -, 10' F: 24HR PREC IP SEE' I . A. 2, PG. 4 FOR REQUIREMENTS. <br />'° .: ..: .. <br />(3wI"•I-LY .... f•. 6?L_S. agS9 INSTRUCT IONS I. C:. 1"), PG. 9Ni. <br />0 <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. 3 ,10 116 ?-?kf5ffi rTn PAGE ;OF