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PERMITTEE NAME/ADDRESS (Include Facility Name/Location if Different) <br />NAME <br /> l tc`1'. i+ <br />ADDRESS <br /> (! <br />?12•? <br />t"?r? <br />1 <br />•" <br />I LZ <br /> . <br />A a <br />y <br />t\ <br /> <br /> <br />FACILITY }+}tilt : , i <br />LOCATION ' <br /> <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />` 01ERWY NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM l ins TO >., <br />i <br />Form Approved. <br />OMB No. 2040-0004 <br />tvl .- F !yr-1 X <br />N6TEF F ad"SrSstrl?Ctionslbef ore mmpletIng this form. <br />I Z7. <br />PARAMETER <br />QUANTITY OR LOADING <br />QUALITY OR CONCENTRATION <br />NO, <br />FREQUENCY <br />SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />Teti SAMPLE '.?:.... c:`.' := •r r.....t. i?:1 <br /> MEASUREMENT <br /> PERMIT •.f t ..... - ,.. ? s; ?? :?, at ,....?';s•s1. .. f a H •?', ., <br /> REQUIREMENT- <br /> t f t- r r n <br /> <br /> SAMPLE <br /> MEASUREMENT <br />a t ?}ray1 <br />%i +?3 i; <br />°% PERMIT <br />r' . z .. ,, <br /> REQUIREMENT . <br /> ?W 'T 41 <br />?::LI'tw:. SAMPLE <br />,• " <br /> MEASUREMENT <br />r PERMIT <br /> <br />, <br />% <br /> <br />a <br /> REQUIREMENT <br />r-. t <br />t ..,, <br />f <br />s <br />r <br /> <br />r <br />e SAMPLE ,r. <br />. <br />t . .. { MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />2 - •f ye•a 6• 1s': <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br />, <br />r, <br />• <br />`` <br />{ <br />PERMIT <br /> <br />if tit. <br />{ <br /> <br />..i <br /> <br />.k ar ... <br /> <br />`Lyi <br /> <br />?" ,R <br />t <br /> <br />i'i <br />f <br />.1 <br />1 <br />.. REQUIREMENT • <br /> <br />. ,. _. _.» <br />,_? <br />SAMPLE <br />y... .. <br />.. <br />(i ? <br />1... .. <br />s "r?. .F' <br />R .. s., <br /> MEASUREMENT <br />¢-„E ! PERMIT <br />r F , E :r A .. 2 <br />" REQUIREMENT <br /> <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER 1 certify under penalty of law that this document and all attachments were <br />re <br />ared under m <br />direction or <br />rvisi <br />i <br />d <br />ith <br />t <br />d <br />i <br />d TELEPHONE DATE <br />f <br /> <br /> <br />' <br />.j <br />6e <br />)Qns <br />540 t p <br />p <br />y <br />supe <br />on <br />n accor <br />ance w <br />a sys <br />em <br />es <br />gne <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 />_ <br /> <br /> <br /> <br />#,r xf <br /> <br />? <br /> or those persons directly responsible for gathering the information, the information <br /> <br />Fs+,?+ submitted is, to the hest of my knowledge and belief, true, accurate, and complete. <br />I <br />th <br />t th <br />i <br />if <br />lti <br />t <br />f <br />b <br />itti <br />f <br />l <br />i <br />f <br />ti <br />IGNATURE OF PRINCIPAL EXECUTIVE B? <br />Le <br />" TYPED OR PRINTED am aware <br />a <br />ere are s <br />gn <br />ican <br />pena <br />es <br />or su <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 EXPLANA I IUN OF ANY VIULA I IUN5 (FletererlCe all attachments here) <br />t <br />? '•. ?'i , ,- E :I .ate ? + 4 tt^.?`F, VI?"lry z. i..l'. .. ?. y?,I <br />93 E ry <br />..: !?4 '.{....r q <br />.....?17 ttl!- W".F ..J1. u.. <br />?,µ <br />a.. . •??,,.... 7 ?4 _.J I` .ol.. ?t . I.'?`I!':.sleiV •.. ?'i <br /> <br />r7 AA .........4F 0.*.-?i, 1. .a .. - (. '. ' t 1 -• <br />" p <br />+.' t <br />C,+ .7 ? <br />' <br />>? i.+i <br />`j <br />}•':-l?? <br />( ! + f .? <br />r Y <br />S f"ti .. - <br />.J .> t... .. -c <br />EPA Form 3320 1 (Rev. 3/99) Previous editions may be used. art fpIri]. PAGE OF <br />T11)S_l a,4 , <br /> ,