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PERMITTEE NAME/ADDRESS (Include Facility Name/Location if Different) <br />NAME ¢ _ . t a F <br />ADDRESS ' . <br />FACILITY <br />LOCATION i _ .. _ n <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO , -, I . . <br />Form Approved. <br />OMB No. 2040-0004 <br />t i. t' <br /> <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />f `? < SAMPLE <br />-49 <br />4 <br />?' ?? <br />t(? <br />INS1? <br /> MEASUREMENT , <br /> PERMIT .: ..f : i ,. 1 1:: ;. ... •. .."?':' ey ,:} t.lf n'. 'r F, i? - <br /> REQUIREMENT <br /> SAMPLE <br />2t <br />?? <br /> MEASUREMENT <br /> <br /> <br />;.._ _ ._ <br />PERMIT 3F 11!?17 <br /> REQUIREMENT rsiI'l_ <br /> SAMPLE t -_ _? <br />P-A <br /> MEASUREMENT <br />"?= PERMIT 4_ . ,. R"( }. ._„ <br />... - REQUIREMENT AVG <br /> SAMPLE <br />< 4-0 <br />l ` <br />2-'-30 <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT MONTH <br /> SAMPLE <br />Z? <br />S <br />2, <br />? 3 } <br />VJ <br />2? <br />?Q <br /> MEASUREMENT . , <br />?]. ?. PERMIT ?:?e ?. ?. .. +tr. R7' €Z 1Y? .?_?_.... 317 ..- <br />' REQUIREMENT ;sfi7 Aue r ,i_ « w: :l lliv f:._ Mf )tai CN <br />F <br />; <br />FL-Ok. SAMPLE Q 06 % o <br />ok (/* <br />tv" <br />r <br />} s MEASUREMENT . <br /> <br /> <br /> <br />•• PERMIT <br />j7} .-l?`ry <br />1 <br />i <br />lli _ I__ Y <br /> <br />1lc.' : <br /> REQUIREMENT <br />tzT SAMPLE <br />JI?v <br />Va W, I MEASUREMENT <br />- <br />_ <br />PERMIT _ F r- FItt R T , is a n .. <br /> <br />` 1 Y <br /> <br />''3 •?1 i lL <br /> REQUIREMENT; <br />i _. <br />NAMEITITLE PRINCIPAL EXECUTIVE OFFICER 1 certify under penalty of law that this document and all attachments were TELEPHON E DATE <br /> prepared under my direction or supervision in accordance with a system designed <br />??? I ?•[?t {`1•f'?f to assure that qualified personnel properly gather and evaluate the information <br />Based on my inquiry of the person or persons who manage the system <br />submitted <br /> , <br />. <br />or those persons directly responsible for gathering the information, the information <br /> <br />\? 1 CF- D FAT- <br />Y <br />submitted is, to the best of my knowledge and belief, true, accurate, and complete. <br />GNATURE OF PRINCIPA CLI t?- <br />( "`+ 1 <br />01 ?j <br />y? <br /> 1 am aware that there are significant penalties for submitting false information, <br />OFFICER OR AU <br />HORIZED AGENT AREA <br />TYPED OR PRINTED including the possibility of fine and imprisonment for knowing violations. T CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments nere) <br />" 4, <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. i .`'Thiis is A 4-.pb ff6rTn. PAGE 1OF