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PERMITTEE NAME/ADDRESS (Include Facility Name/Location if Different) <br />NAME i.-:'AI_ NIVI r <br />ADDRESS I'> 1. NIE <br />FACILITY r ?5 tist r - 1 <br />LOCATION(, <br />1 ._ EE's <br />1=t-.;r.Ts1F- <br />Form Approved. <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) OMB No. 2040-0004 <br />DISCHARGE MONITORING REPORT (DMR) M I; <br />RT1r <br />0V <br />PERMIT NUMBER DISCHARGE NUMBER F ITI` A _ <br />tfT !s. <br />fZ S I.r 'r.-fS #'i_.7(..I». 1,'31TCH#3i <br />TI: <br />MONITORING PERIOD <br />YEAR MO- DAY Y MO. DAY <br />FROM a.. TO >.. 1 _ . <br />NOTE: Read Instructions before completing this form. <br />PARAMETER OR LOADING <br />ITY QUALITY OR CONCENTRATION NO, FREQUENCY <br />OF SAMPLE <br /> . EX TYPE <br /> ANALYSIS <br /> AVERAGE / MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />.. SAMPLE -4.69 4.9 <br />I <br /> MEASUREMENT <br /> <br />t PERMIT <br /> <br />' <br />, <br />` <br />_ REQUIREMi NT f'1TN I~1i:,tf'1 F k i"iU'f1 -, i #"C3t?TM <br />r,;?.. <br />? <br /> SAMPLE 3 r G I7( <br />/ 'LI <br />3O <br /> MEASUREMENT - <br />r. t. PERMIT x.....,a-k••ii'•#•. <br />n ?, •'4'-##3f'`". '. <br />.. •>~ _ _ .._ 1 <br />.: <br />' <br />* , - <br />?-e <br />' REQUIREMENT 3'}C3Fi si r MX 'U A- ) T <br />MCIN <br />`S <br />VALUE <br />_ ._ . _. , SAMPLE { O ` ?. i 2J3O <br /> MEASUREMENT <br />1: PERMIT n i^ y 4r # „. }? t # 4t jr ; : i." , ._ w T T- r' . Y <br />.., <br />t z'' # U REQUIREMENT' ;;'3# jA ;'I VG DA t._`I I`1X t! MONTH, <br />"C SAMPLE <br />4-0 <br />?/30 <br />Cs <br />11AD,L E MEASUREMENT <br /> PERMIT i 4; itT e °• <br /> <br />V,?-?L.Ij; <br />L _1L! t?s ^' 1v.. " <br />REQUIREMENT , <br />W a <br />i 1. Y' #`} <br />;"°TI? 'T 1I <br />a 33 `. SAMPLE <br />? T ,i_ , „ <br /> <br />;'}L11 <br />y j)153 <br /> <br />MEASUREMENT <br /> <br />' 0 'o <br />I <br />PERMIT <br />?: ;?ik•l;'ir <br />i; x +. F ya k <br />., .. ' <br />??< -+5 <br />?; F <br />., t <br />. . t/ <br />"i ?. - <br />_ <br />U` REQUIREMENTS K X17 = ?Jd` D Al i_ #?lI°INTH <br />F r_ <br />_ <br /> <br />AN-' <br />s 7~ $' <br />t r SAMPLE <br /> <br /> <br />MEASUREMENT <br /> <br /> <br />OIU <br />I <br /> <br /> <br />fs ?a?? <br />. <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />rr <br />+ <br />\II S <br /># MEASUREMENT <br />.. PERMIT <br />r r -K ? tl.i y-i l x <br /> <br />L MONTH <br />1.+ REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER 1 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 />' to assure that qualified personnel properly gather and evaluate the information <br />ersons who manage the system <br />erson or <br />n m <br />i <br />i <br />f the <br />B <br />d <br />b <br />i <br />d <br /> , <br />y <br />p <br />o <br />nqu <br />ry o <br />p <br />ase <br />su <br />m <br />tte <br />. <br />ersons directly responsible for gathering the information, the information <br />or those ((( <br />` <br /> <br />r' <br />I A12T?tIC <br />?'??+D vl <br />?' <br />(c'E?1Dr`/? <br />C <br />/ p <br />submitted is, to the bekl of my knowledge and belief, true, accurate, and complete. <br /> <br />CUTIVE <br />S NATURE OF PR INCIPAL ' <br />?? - ?rl) <br />0 <br />. <br />: <br />t . <br />1 <br />I I am aware that there 4re significant penalties for submitting false information, AREA <br />' the possibilify of fine and imprisonment for knowing violations. <br />includin OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />PRINTED <br />TYPED OR g <br />COMMENTS AND EXPLANATION OF ANY VIULATIUN5 (Hererenre an arracnmenrs nerej <br />. 1 <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. <br /> <br />PAGE 70F <br />)02','30 , -.Th srO a 4-p 'f?itTn. <br />Y1 <br />!I