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Form Approved. <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) OMB No. 2040-0004 <br />PERMITTEE NAME/ADDRESS (Include Facility Name/Location if Different) DISCHARGE MONITORING REPORT (D R) <br />NAME <br />ADDRESS ' H, ; ; . . , .. " ` DISCHARGE NUMBER r , <br />PERMIT NUMBER <br />Ill: y •.; : y, i MONITORING PERIOD I <br />FACILITY t YEAR MO DAY YEAR MO DAY <br />r TO ; ? L <br />LOCATION _ FROM <br />;•,, r ; . NOTE. Read Instructions beforercolaipleting,this form. <br />FREQUENCY <br /> <br />PARAMETER QUANTITY OR LOADING <br /> <br /> AVERAGE MAXIMUM UNITS <br /> <br /> SAMPLE <br />MEASUREMENT <br /> PERMIT <br />REQUIREMENT # ;... <br />` <br />i s <br />1 <y. i ; <br />! fCli SAMPLE <br />MEASUREMENT <br />b_ <br />C", +.y t t PERMIT <br />REQUIREMENT r K r: xE•# # i;• c: ,t st ; <. <br />F I , J <br /> <br />V EF A ,I r., SAMPLE <br />MEASUREMENT 3s zf * , n <br />r i•. PERMIT <br />EQUIREMENT K IS) .i d# A ;t i a i% I. <br />.., .,?.. <br />? , r - t; ?.:? •',t,..l <br />t' 1." L I <t V G" 3 R <br /> <br /> <br />t <br />SAMPLE <br />MEASUREMENT C <br />„ <br />S (tJ?? a <br />- PERMIT <br />REQUIREMENT ?: t s .• #,. !r ,.,;rz 3 # tc <br />t l <br />Z 1r.,Jr• SAMPLE <br />TOTAL i An, MEASUREMENT <br />{. $•i i r :?j PERMIT <br />I IREMENT <br />RE i.°•f.•3z t:•sz•?• •fit•.i?•.t?•!'.:-3T -iz• ,4:' <br />9S iY!"cl. > <br />?1.'1.? .. 1,.1,.. Q <br /> SAMPLE ? x " ?G 3i 7i• 3r ii # 1: 3 <br />TOTAL MEASUREMENT <br />. <br />sz1•.. , PERMIT <br />REQUIREMENT ###t t ## # a '.. <br /> <br />K ,:..it <br />FTL tad r- I i i;?z _, p l¢ : <br />SAMPLE s x <br />MEASUREMENT <br />PERMIT r. .c + k <br />r _ a t REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certify under penalty of law that this document and all attachments were <br />prepared under my direction or supervision in accordance with a system designed <br />^ f _? to assure that qualified personnel properly gather and evaluate the information <br />f{L:..:7 k submitted. Rased on my inquiry of the person or persons who manage the system, <br />- / or those persons directly responsible for gathering the information, the informati, <br />submitted is, to the best of my knowledge and belief, true, accurate, and complete. <br />W C ! I,%?? 1_j? - t? I am aware that there are significant penalties for submitting false information, <br />TYPED OR PRINTED including the possibility of fine and imprisonment for knowing violations. <br />II ttachmentS here) <br />QUALITY OR CONCENTRATION NO. OF SAMPLE <br /> EX ANALYSIS TYPE <br />MINIMUM AVERAGE MAXIMUM UNITS <br /> <br /> ' <br />. r:? ci. S• I.••}?.?..qs. rfr, :? I ? ?I?I??' ?,`?(-? <br />?; I <br /> <br /> <br /> 30 rtFIm1".. 'f 'C7t"IprjF <br />#at r L <br /> <br /> <br /> <br />• £ :. U RE:f= OP {.. <br /> <br /> <br /> <br /> <br /> <br />•ff••'<.•3?••Si^•yu,••tp. Soo •l'0'+..0 9 ;W.EIhL.Y ?i?tl'•ff ??-. <br /> <br /> <br />rf p? O 1? e-1- O ? 3 l ? ?.L ti' : t 3 ibi F' ?? <br /> MIX <br /> <br />•3t••Iw`•3£°#•3t•i« i1•?###•?I•? iC7 r (_,N?i• IR# •i'?i•?:' <br /> <br /> TELEPHONE DATE <br /> <br /> <br /> <br /> CIPAL EXECU VE <br />`' s f <br /> SIGNATURE OF PRIN <br />OFFICER OR AUTHORIZED AGEN AREA <br />CODE NUMBER YEAR MO DAY <br />'? <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference a a <br />:P ':+R1 iP+i:. : I'+ESTRF JCTSt NE". ... s.,K I. ?. 91 t A -E _ J L.. I. G. 1. .). <br />1?Y rp x <br />PAGE OF <br />{ J. <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. jqrm.