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` Form Approved. <br />PERMITTEE NAME/ADDRESS (Include Facility Name/Location if Different) 5 NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) OMB No. 2040-0004 <br /> DISCHARGE MONITORING REPORT (DMR) > T i JR <br />NAME <br /> <br />ADDRESS 4 -t) ; c. t 'z PERMIT NUMBER <br />?•l.. <br />DISCHARGE NUMBER I 'I <br />I r3 <br /> 'TO <br />- ~ f y <br />I <br />` - ' MONITORING PERIOD <br /><_ <br />FACILITY i ;.; <br />YEAR MO• DA <br />YEAR MO. DAY <br /> <br />LOCATIONe, <br />FROM <br /> <br />_ <br />?TO <br />before <br />NOTE. Read Instructions completing this form. <br />- <br />NO <br />FREQUENCY SAMPLE <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION . <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />ax a , ,_ SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />?' hi'? !L.. <br />3_11.1,'-at DAILY MG <br />MONTH <br />EF REQUIREMENT <br />r =... ._i.. i' SAMPLE <br /> MEASUREMENT <br />1 J <br /> <br />E L. PERMIT #3 r < it': tom. <br />: ####ir# I <br />•? DAILY' ! to f_1•.... <br />A Any <br />0 C <br />3 <br /> <br />I"fONl <br />,,.. _. <br />?' L. J1_.:. f ... ;'r"x`.•iJx. ... ., ?.._ <br />REQUIREMENT 4 <br />. <br />X <br />.( <br /> SAMPLE <br /> <br />v ?) <br />MEASUREMENT <br /> <br />1 - <br /> <br />? f <br /> PERMIT <br />-'G DAILY MX h <br />0A A <br />MONTH <br />E F=L s .: t F lJ . REQUIREMENT %1 <br />30 et <br /> ..t t <br />, <br />F - SAMPLE <br />T UTF _ F i_E MEASUREMENT CZ7 <br /> <br />i ? <br />PERMIT ???-??•tg '3F rw.:?-? •?•?-ti••st- # <br />? 11?y f Y1f7 DAILY <br />~3t <br />nS'Z •r' <br />s <br />lt <br />! :.f". -1'? <br />, r'?`(, <br />,,? <br />®IY t { t <br />S <br /> <br />- .r f ' tJ <br />EFFL t - ; <br /> <br />REQUIREMENT _ <br />E <br />c Y, t <br />. i is <i :1# r <br />; SAMPLE <br /> <br />t"1 [ yr I'1 lr! A. _ r <br />TOTAL I t C. MEASUREMENT <br /> <br />' <br />.s <br />t'C <br />" <br /> <br />L <br /> <br />..r <br />4 <br />1 :. #'.i• <br />',f.##?•.',I•'? #x -:#'#-st•, •3E <br />PERMIT # <br />?ii°# <br />Y <br />AVG IA T L <br />AV G <br />.,30DA <br />MX JtT.` ( L.. - <br />T <br />MONTH <br />EN U <br />> FFL r.3 REQUIREMENT # r , _ <br />^ t <br /> <br /> SAMPLE <br /> <br /> ERfifBL.iY MEASUREMENT <br /> <br />.r 1,ff f <br />I ,.} <br />i t <br /> PERMIT <br /> <br />..:? .?.. .;t <br /> <br />f....TiA A ?`L 7' <br />3', <br /> <br />DAILY <br /> <br /> <br />X <br />i f <br />t..rtz.... <br /> <br /> <br />ONTH <br /> t o !_IJt <br />FF•FL <br />i t •? r;> <br />t REQUIREMENT ,. <br /> <br />_ <br />. t <br /> SAMPLE <br /> <br /> ( { rt .F•f MEASUREMENT <br />1 <br /> PERMIT 7 71,?, #34 iE€t # # h. <br />30DA 'AVG ! <br />DAILY <br />MX. <br />liG* r'L.. <br />11(7C?ETH <br />-. <br /> REQUIREMENT <br /> f law that this document and all attachments were <br />lt <br />d <br />TELEPHONE <br />DATE <br /> NAME/TITLE PRINCIPAL EXECUTIVE OFFICER y o <br />er pena <br />I certify un <br />ared under my direction or supervision in accordance with a system designed <br />re <br /> t' I7V nn <br />f J_ V <br />t p <br />p <br />to assure that qualified personnel properly gather and evaluate the information <br />submitted. Based on my inquiry of the person or persons who manage the system, <br />rmation <br />th <br />i <br />f <br />i <br />f / <br /> <br /> <br />! <br />, <br /> <br />+ <br /> e <br />n <br />o <br />ormat <br />on, <br />or those persons directly responsible for gathering the in P <br />( f"r V <br />_2 t , ' J <br /> <br />to the best of my knowledge and belief, true, accurate, and complete. <br />submitted is <br />SIGNATURE OF PRINCIPAL EXEC IVE <br />I y <br />F <br /> !Z I D f /?l' , <br />I am aware that there are significant penalties for submitting false information, OFFICER OR AUTHORIZED A NT AREA NUMBER' YEAR MO DAY <br /> TYPED OR PRINTED including the possibility of fine and imprisonment for knowing violations. CODE <br /> COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. 00036 / 0 AM 14a-41p-d3Cbr 1. PAGE r? OF