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PERMITTEE NAME/ADDRESS (Include Facility Name/Location if Different) <br />NAME <br />ADDRESS L". 79 i <br />FACILITY <br />LOCATION <br />p -",Ip 1L F <br />AT 'T <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 :..t .I TO _ I. V <br />Form Approved. <br />OMB No. 2040-0004 <br />MINOR <br />( S:; Tlf 1.- 11 <br />t <br />. t <br />TO TRC LIT C,H EE-K <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ, FREOUENCY SAMPLE <br /> OF <br />E <br /> EX ANALYSIS TYP <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />F 1-i SAMPLE iF # • -.: -3o- : t t t x ,#t <br /> <br />?5 ( 1 7_7 <br />ad <br />+ <br /> MEASUREMENT <br />' t <br />NS <br />004C .-O PERMIT # # ?1F# # , # # w . -E I', RK <br /> REQUIREMENT y x. t; Ft I l?! I M1.11 MAX I MUM U MONTH <br /> SAMPLE <br />21 <br />_ <br /> <br />- $ <br />!` 1 F L:tal;!. r. <br />S;1. MEASUREMENT <br />C7 t. FO73?G, ? PERMIT df#??4±# # t}F##?I 4?i?x i 3?#fi#? r+5 <br />]~FH L. JT Nv 3 a ^ : `JriL 11 REQUIREMENT :30I3f c #)G MX 7I} AV MG/L MONTHS ; <br />SCbL D `F.'- SAMPLE i?:a.. <br />I <br />I <br />X3 <br />?? Q <br />?B <br /> MEASUREMENT C O. C). 0 + <br />1 Cl5?? t' a PERMIT 3t tit 5- -o- t 'f #34### x #:4#iiiF't _ aRI • <br />FFLUENd' VA3__IJt REQUIREMENT {•# ti 3QD DAILY MX 11L./L. <br />TROI`1t SAMPLE r; 3t# # st# ; ## s a t f I <br />0T'Ai_. r t ',;, } 7''?Ii? . MEASUREMENT L}0 i 2f'A' 6 <br />f <br />00,7 `z 1 !' t <br />PERMIT ## $• ?E # # si # 3t # #if # § 3r # # )00 ail' . <br />EF 1- .UENd , 71--' 3 .:l 'i i._JF REQUIREMENT; ? #ii al :3G?f?i? 46 1?A I LY MX X tJS»f L <br />i'IFaiC Ott`"sf_ SAMPLE #_ it### 41•# 4 ## ##..•-ii <br />POTIr N'1- I ,I_ __ `i ;.; 1,35S OLVi. MEASUREMENT 13.5 Z.U C3R11B <br />?t11.9 PERMIT a?ai- ?r is##x#st #.. ##sl it a <br />EF'FL UEItiI l zt'? 1,:. 3 VAL.U <br />E EOUIREMENC fs tr t "'. 0DA A 1?ATLY Mx tJ??I) <br />., • <br />r?, y <br />Lt' J. G.. t^'2 7 ,`S'r .Cx? S L ."..'? E <br /> <br />SAMPLE <br />-it -5' f J$" t' 31' : <br />:. <br />°SY"'#' :,? •#'. ;"f' <br />7?• 7`t' 1 <br /> <br />S <br /> <br />4 <br />' <br /> <br /> <br />A <br /> MEASUREMENT Q A N <br /> <br />,?. t.: <br />35EP`=? PEAMIT <br />3t• -1o- ? # <br />•;t •!a # 3} <br /># # -af• <br />C. ` <br />EFFLUENT ?1i_(JI? REQUIREMENT <br />{7 <br />### ?, <br />'045T MAX <br />MG/L <br /> <br />F°L.L3W, 1` U L _ T SAMPLE <br />I t <br />( <br />( <br />3Sg st # R, .. t <br />/4- <br />tn1S <br />THRL< TR,11-40 MEN T PLAN MEASUREMENT 0 <br />. . ?LJ <br />t'tQic,c1 t a PERMIT <br />71 <br />EFFLUENT VALUE[ REQUIREMENT ?300A -AV(:; DAILY llu ,,1(-r t ? ?4## 7 <br /> <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER f certify under penalty of law that this document and all attachments were <br />e <br />a <br />d TELEPHON E DA TE, <br /> <br />tY I YR) D <br />/ r <br />prep <br />d un <br />er my direelun or supervision in accordance with a system designed <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 />t / C / <br />"ZZ <br />Gi Drw <br />'f , <br />or those persons' directly responsible for, gathering the information, the information <br />. <br />- <br />f <br />V G- -- <br />submitted is, to the best of my knowledge and belief, true, accurate, and complete. -r? <br />v <br /> <br />I am aware that there aresignificant penalties for submittin <br />false information GNATURE OF PRI CIPAL UTIVE ?I <br /> <br />TYPED OR PRINTED g <br />, <br />including the possibility of Ime and imprisonment for knowing violations. <br />OFFICER OR, UTHORIZED AGENT <br />AREA <br />NUMBER <br />YEAR <br />Md' <br />DAYJ <br />,COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Referenceall attachments here) <br />D FOR J 10YF , 24HR PREC. I P EVES- -° SEE I . A. 2, <br />SET I LI off.{i._. D; L.. "I.i'? WILL BE WAIVE <br />;; PG. # FOR REQL IREI MENTS. <br />f ;aRTRL')•' ;3A I LJNG INSTRUCTIONS -• 1. PG. 9. <br /> <br />PAGE OF <br />?' EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. 0 0 13 3 /.0-PhW0 A *-J,S5ffiTiit. 1