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PERMITTEE NAME/ <br />NAME <br />ADDRESS ' <br />j? <br />FACILITY <br />LOCATION <br />4DDRESS (luclude Facility Name/Location if Different) <br />Form Approved. <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) OMB No. 2040-0004 •. <br />DISCHARGE MONITORING REPORT (DMR) t 1=;f:1F <br />r <br />4' ... -'Y . r::) P'y'{i'•C.. <br />PERMIT NUMBER DISCHARGE NUMBER f ) ,y••"?j., <br />t <br />MONITORING PERIOD <br />YEAR, MO DAY YEAR MO DAY <br />FROM TO <br />NOTE. Read Instructions before completing this form. -- <br /> •; <br />PARAMETER <br />QUANTITY OR LOADING <br />Q <br />UALITY OR CONCE <br />NTRATION NO. <br /> <br />EX FREQUENCY <br />OF <br />ANALYSIS SAMPLE <br />TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />" <br /> <br />ftF1T,,.. SAMPLE ;c 4t . <br /> ASUREMENT <br /> il <br />C)> <br />? <br />r ME <br /> .,., <br />: <br />_ <br />a <br />I PERMIT <br />REQUIREMENT <br /> 't'. M 41 1G <br /> s-c x SAMPLE Fit <br /> I:. <br />hEa I <br />E:Cf?VI MEASUREMENT <br />" <br />=r <br />? <br />a <br />Y' <br />L <br />1?1?4 ks <br />?i;Rt"i C? <br /> s <br />: <br />K <br />PERMIT <br />REQUIREMENT r . si- tg 3f { .n. 'E t o if it <br />. <br />## i <br />r <br />r ., <br />T <br />F. F 1 <br />G <br />. <br />. <br /> T 0-1_.UP:NT r 'JS L3 4 e L ik <br /> <br />. <br />t <br />if dk. <br />r 17) <br /> ,:1 SAMPLE * <br />. <br /> Iry T i l"1 ,?; MEASUREMENT <br />x f ( <br />! <br />sr I F' <br />l <br />`' <br />rC i , a3 y <br /> 1 ' 1 PERMIT <br />IREMENT r r Zr # ..}y sI i! ;#• I .: <br />? . <br />_ <br /> _ REQU <br /> SAMPLE :. '•; sf r ., :r"-: <br /> <br />MEASUREMENT <br /> <br />t ) ( <br /> <br />l i= V y , <br /> <br />? OMF" t_r`: <br /> sl <br />a <br />PERMIT <br />REQUIREMENT <br /># k <br />3r .A.ucx : <br />- , <br /> <br />{i£l?t <br />rz. <br /> F k' I IJENT Tiv 4 9f i <br /> s tl .. SAMPLE : . <br /> ?f _I_R <br />? i'i....s'' MEASUREMENT O NT N U 0' <br /> ? <br />?tl`;7 L <br />ZFFL-JFNI PERMIT <br />REQUIREMENT 7. Q;. <br />ti 0 r b'C <br />DAILY Mv% <br />`IGI.: <br /> <br /> <br />36•#?'t-•'s••sr <br />x <br /> <br />- <br />UOU:s <br /> tr nl ja <br />If. t? t'r, SAMPLE #3('•SE•#if••k• -?t.•r. 1... <br />? <br />t ° <br />f \ t1t <br />I"RA4 MEASUREMENT • EKLY :0111 C2 i <br /> . <br />. <br />1~ <br />t <br />_ 3 r <br />? r <br />. PERMIT - <br /> <br /> <br />. <br />REQUIREMENT 3i #b 3F # 3F i s g. -? r t # <br />t dE # i#if I oct <br />;.a0LIA ' '../ 2,0 <br /> <br />1, <br />D,',11 Y M <br /> <br />4 <br />` f ` i. <br /> y { t <br />p <br />C P l...IJ ?',.1 •?7 rFC ?•C /f'?L_E.i l. <br />! cy , <br />i•3. <br />r- tr ?: 1:": •S. n ,. <br /> r r. F.' ':.• <_: <br />IL_ T'it` x? SAMPLE 3 ?*"zF;r . <br /> 1UAI MEASUREMENT <br />t <br /> <br /> <br />' <br />40 6 I <br />F?" I UI i'a ° ALA P PERMIT <br /> <br />: REQUIREMENT z 3t P:..> I R t'"3R 4• Y <br /> <br />I N y`C 11A X <br /> <br /> <br />nt and all attach <br />d <br />hi ES <br /> <br /> <br />+7f <br /> <br />ments were " ii si• t . ar## <br />t <br /> <br /> <br /> <br /> <br />•^ { <br />M <br /> <br /> <br />TELEPHONE <br /> <br /> <br /> <br />ATE " <br />' NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certi <br />prepa ocume <br />s <br />fy under penalty of law that t <br />red under my direction or supervision in accordance with a system designe d `, -- x ! { <br />\ '^ 3 <br /> <br />?-, 1 I !-?' <br />t J - A /T <br />"" <br /> <br />CLA) v/ <br />to assu <br />to <br />submi <br />or tho <br />re that qualified personnel properly gather and evaluate <br />tted. Rased on my inquiry of the person or persons who m <br />se persons directly responsible for gathering the informat <br />accur <br />ue <br />li <br />f <br />t <br />d b <br />the information <br />anage the system <br />ion, the informat <br />and complet <br />ate <br /> <br />, <br />ion <br />e. <br />?•^-_.. <br />, <br />^/`?-?, <br />PA <br />' <br />\ <br />?.....-•-•--. <br />L EXECUTIVE <br /> <br />.ir n <br />1 <br /> <br />2 •j ! . j "r'? <br />(( T" V <br /> <br />, <br />--. <br />f" <br />. <br /> •' <br />?.-7 (" <br />t ) submi <br />1 am a , <br />e <br />, <br />r <br />e <br />tted is, to the best of my knowledge an <br />ware that there are significant penalties for submitting fa , <br />ke information, SIQFI <br />OF TORE OF PRINCI <br />FICER OR AUTHORIZ ED AGENT AR <br />CO EA <br />DE NUMBER YEAR MO DAY <br /> TYPED OR PRINTED includ ing the possibility of fine and imprisonment for knowing violations. <br /> COMMENTS AND EXPLANATION OF <br /> <br /> <br />.. •tr tl i_ s t.l,? <br />GifARl l-:R ANY VIOLATION <br /> <br /> <br />_. r -,- ?.,,, .t. S (Reference all attachments here) <br /> <br /> <br /> <br />la fi? z?I <br />??: <br /> <br />. <br />.. F .... <br />t , 1. <br />. <br />t <br />PAGE OF <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used.