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Form Approved. <br />PERMITTEE NAMEIADDRESS (Include Facility Name/Location if Different) NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) OMB No. 2040-0004 <br />NAME ' s. 't < ; ., t ; y,_ CIA L M 1 [4 ? ( DISCHARGE MONITORING REPORT (DMR) M I NOR <br />ADDRESS ` i.)WR J;_ 1 <br />t: s T r l} a` /PERMIT NUMBER DISCHARGE NUMBER F F .T, NAL, "C ?; <br />i ?..re... '•'?+: s l i:s7 _??%J,'}.e% r ;J',.J.- ?.. :. $'?iv??• -(-0 €i"r t,1! Lr;E..=6" <br />FACILITY <br />LOCATION r- 5 - ti 7, 167 <br />it .??L.?'P JE L.E., C`-'fir <br />•t ;fix. ;4?_' L ?''I•ifii'? ?..ti?. i ......... s .: .q n <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY/OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY SAMPLE <br /> EX TYPE <br /> ANALYSIS <br />, AVERAGE MAXIMUM UIJITS MINIMUM AVERAGE MAXIMUM UNITS <br />zL <br />,, <br />i -- "oI'Jr., G`"?sEN. l <br /> <br />SAMPLE <br /> <br />:5 <br />..?'#:$': <br />i•,[ <br /> <br />( <br />n <br />i <br />£ -.F ;t ,. <br />_:i. .,*+. <br />. . . ..:fir. 1 <br />i <br /> <br />l <br />MEASUREMENT ` <br />f <br />' <br />1 x ` <br />. €;L. <br /> <br />_F F Ix ; 3?3 W',,I. U <REQUIREMENT' I r4S MA l C; MON 11 <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />f <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT fi <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certify under penalty of law that this document and all attachments were <br />dire <br />d <br />nder m <br />ti <br />ervision in accordance with a s <br />t <br />m d <br />i <br />n <br />d l <br />/ TELEPHONE DATE <br />np.? <br />1)ry ?I 17 t ?" IF I t ` I p ?i- prepare <br />u <br />y <br />c <br />on or sup <br />ys <br />e <br />es <br />g <br />e <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 "? f t s )? `r <br /> , <br />or those persons directly responsible for gathering the information, the information <br />r JJj+ U??- C <br /> <br />p <br /> <br />/-1 <br />n <br />Y I F f C f,(? ?fJ I submitted is, to the best of my knowledge and belief, true, accurate, and complete. <br />lti <br />f <br />I <br />th <br />t th <br />i <br />if <br />t <br />b <br />itti <br />f <br />l <br />i <br />f <br />ti s1 ! I `1 <br />SIGNATURE OF PRINCIPA?IS ECUTIVE y l.) ;) <br />j 2ot o 1 2- 2- <br />.v <br />TYPED OR PRINTED ican <br />or su <br />am aware <br />a <br />ere are s <br />gn <br />pena <br />es <br />m <br />ng <br />a <br />se <br />n <br />orma <br />on, <br />including the possibility, of fine and imprisonment for knowing violations. OFFICER OR AUTHORIZED AGENT AREA <br />CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATIUN UI- ANY VIULA I IUNS (Hererence an arracnmenrs nere) <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. ?2? r'his'is 4-+&&f8rm. PAGE OF