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PERMITTEE NAME/ADDRESS (Include FacilityName/Location itDifferent) <br />NAME <br />"'U"'.. _. lG. <br />Lx <br />ADDRESS VH1RL 611 11,1D FR ;.E i <br /> <br />Nib`: <br />FACILITY <br />LOCATIONt A ? 3 , r 1 <br /> <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) Form Approved. <br />DISCHARGE MONITORING REPORT (DMR) M I NOR OMB No. 2040-0004 <br />l_t ){}" ,i7r l"Fi.7 t i UZ'if i)W .-' . <br />PERMIT NUMBER DISCHARGE NUMBER Mr..5AN <br />cs <br />MONITORING PERIOD lc? T vS.l rt?-1• i1s5i.,HG Ti 1_. .?I`i D r.i CR <br />YEAR MO DAY YEAR MO DAY <br />FROM TO ?u s #i f 1`,4 D1ci C h A R G E 1?1 ##w <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />i x 14M.. I Ei l SAMPLE # it # t =6 :# k # # 3F =: ?t ?t <br />CIISE;r t i A13L. MEASUREMENT <br />00:1-10 I PERMIT #!E3 1## #; #3tsF # 3E## # #d # C/ L2 M .ice <br />EFFLUENT +:. R F 5 V AWE REQUIREMENT 30DA AVG DAILY MX MG rL <br />MONTH <br />iEt° x'L..1._ :t `•s£ t: ': '.;.- SAMPLE :{ :i A-*** <br />:> . d # # ?• <br />## i7 <br />L;3 E J MEASUREMENT <br /> PERMIT 96 #tf## #itit##z? # : a3t ##### t L1• <br />EFFLUENT 9 ROSS VALUE REQUIREMENT 3G'?3A 'A?}?a DAILY 11h IiGi L MONTH <br />€3L7?'Cid; ? 3 k:_. SAMPLE <br />St r1• f3r <br />zr##ii# <br />##it# <br />AS 5) MEASUREMENT t' r <br />r. d_ <br />.i. - _ <br />PERMIT #°4 # it # sE #iF ## ?, t _ 4 <br />umt-u <br />&FL.:UEN T -DROSS VAt-IJ REQ12 EMENT 3C}DA G DAILY MX MOIL NTH <br />Ei-. SAMPLE <br />#it #'- #iE <br />st i ii it <br />st 3i r# tat <br />} <br />TOTE+I. R E'COVErRA L E MEASUREMENT <br />107*4 1 . G- ERMIT # ' # sF## #? ## # ? ? ' 9iiF ?s UUMPOS <br />FFL.iJr;'•3T ''4E)S5 i z-,L.ij R UIREMENT '30DA R;1`G' LSPi M}C /L Whu <br />k-EAD - "" SAMPLE <br />TOT•Pl RECOVERABLE MEASUREMENT <br />01114 1 ".% r% PERMIT #? ## ## ### : # ## #' 3F#### t , <br />FFLU"_'NT -;y: 'S5 4ttt -Ul- REQUIREMENT ## ;30DA AVG DAILY MX UG/L MONTH <br />AEf6D?. `!In t r ; ?• :11...? f. SAMPLE 31##3t ?f ###iF 4, ##' sF q ! ) <br />VERASL E MEASUREMENT <br />, 11c3 PERMIT # 4F3F## #3t# # ?Is!# UMf-Ub <br />EFFI_U "t_UE <br />s?I j7 C ?.>IIS ? Vr. REQUIREMENT 3Q }A Ftt'G DAILY MX UG/L ?"IONTH <br />?HRC?S'iU!f<C_)' PST SAMPLE i? Ws:. ?.x•sF ##?i L cG! <br />TOTAi_ RECOVERABLE MEASUREMENT <br />042C<= #. ! PERMIT it #st# 1F# # #FrFi! O NCE/ t' <br />EFFLUE%•,T r:tj_)SS VA-1-'J E REQUIREMENT ^ h r 300A AVG `DAILY FIX UG/L MONTH <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certify under penalty of law that this document and all attachments were TELEPHONE DATE <br />^ <br />A <br />7 <br />CL( prepared under rry direction or supervision in accordance with a system designed <br />to assure that qualified personnel properly gather and evaluate the information <br />c t-A <br />- <br />, submitted. Based on my inquiry of the person or persons who manage the system <br /> , <br />or those persons directly responsible for gathering the information, the information <br /> <br />/ t <br /> <br />J <br />J <br />?/lJ <br />j <br />-?? submitted is <br />true <br />to the best of my knowledge and belief <br />accurate, and complete. <br />P `/' <br />1"I r f ( <br />A <br />. l, <br />V <br />-- t'- , <br />, <br />, <br />I am aware that there are significant penalties for submitting false information SIG <br />NATU R F <br />lCPAL E CUTIVE <br />RI <br /> <br />TYPED OR PRINTED , <br />violations <br />includin <br />ossibilit <br />of fine and imprisonment for knowin <br />the - O <br />ER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MO <br />° DAY <br /> g <br />g <br />y <br />. <br />p CODE <br />%,vmmcrv t o ruw rrArwrvwt tvrv yr mini T vwLAi tvnto Irierere"ce all aL1aGTOne"ts "ere} <br />r <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. 00043 /0.Tj$*-4ipACYi(fOrm. VAUt L? I car <br />c,_. 1.