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PARAMETER
<br />QUANTITY OR LOADING
<br />QUALITY OR CONCENTRATION
<br />NO.
<br />EX
<br />FREQUENCY
<br />OF
<br />ANALYSIS
<br />SAMPLE
<br />TYPE
<br />AVERAGE
<br />MAXIMUM
<br />UNITS
<br />MINIMUM
<br />AVERAGE
<br />MAXIMUM
<br />UNITS
<br />.' ' .' .";
<br />SAMPLE
<br />MEASUREMENT
<br />.1,'.1.47:,:...:',..
<br />7.?
<br />..n...• , 4,.....7„;...q.:.
<br />1 a
<br />;
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<br />:,'' " '":„''.'!
<br />'.-. :-
<br />7 •7- 1' ,i. :''.• •1:••
<br />..,..„ .,.. ..... ... :.........
<br />:.:•::•:
<br />.1=1EPUREMENT..
<br />•:-.'„7,•-•..- 7, - -. 7 .
<br />:':' :.:' ‘,...', 1., ..:.:.
<br />'-:,:. -:1 r, 4.),::.REQ111REJVIENT:
<br />SAMPLE
<br />MEASUREMENT
<br />.:....
<br />.i."....
<br />......,%. ''.-:::1.-
<br />"-''`.'".....
<br />.::::
<br />. ......
<br />-;•:- ,:. -1.
<br />-.
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<br />Ti.".7 1:
<br />'......'i...i ... ,' ....!--*
<br />".7, :,:,..,.-a-1 ;,'.', .t.t,
<br />SAMPLE
<br />MEASUREMENT
<br />1.:..c..1...
<br />-. 7:'..
<br />,---•-:-:.'..-,:-::..'.
<br />`."." - ; '+' ..".
<br />: '.'"."
<br />PERMIT::
<br />„..:.:.: ...... .
<br />REQUIREMENT
<br />It...i.-
<br />•''.. ':.,',.. ". .;-.'; .*.-'.5.--"...:.
<br />. :: . ': Y '...•', _
<br />1 . * i ,..)
<br />SAMPLE
<br />MEASUREMENT
<br />:.:..7.,---:-..::-.
<br />41.....:-':-'.'
<br />•.■., ....7.if )
<br />"::::1?",'" 1 /...V
<br />r.:":".'.'
<br />- ." : '_"' 1' , :
<br />;REQUIREMENT
<br />ctl P„.1
<br />SAMPLE
<br />MEASUREMENT
<br />:h..:
<br />1 7 .',.. 7 .: -
<br />-...:-'..„,,,.....-•:--:...,:-
<br />' '4.:; ')
<br />',........ ', .
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<br />.•.',:::.
<br />:"-•,:..: , -,1 t`
<br />.....''':: T'''''...
<br />.. - ..:::. • : .•
<br />: : ... . . ..
<br />PERMIT - 7
<br />, .. . ...:
<br />.REQUIREMENT
<br />.. -.-i'.... - '. -
<br />•
<br />:i'..:: .!
<br />- ::T . ,.."_,:.: , 777F, v...4" .1
<br />SAMPLE
<br />MEASUREMENT
<br />.1...; -',. ::,...:
<br />.. ,":... .11 -...' *.
<br />.(.. ..:I.. -: ,.:
<br />PERMIT
<br />.. „...:::. : .,..„.
<br />::REPPiFtEiviENT
<br />.".:',f. "- ';','
<br />,- ;`,;(:■; - -it-- 7 3
<br />SAMPLE
<br />MEASUREMENT
<br />-.1'. L...s.:...-..i. -:...
<br />..,:'‘..:.
<br />:::7..74...".4-
<br />:.r:i....;•'4.• :, .
<br />7: .: ...•..i..:7'... '....
<br />' . " : ..... : • '
<br />: :'.:.:....:.
<br />PERMIT . ...
<br />: REQPIREMENT.
<br />. 7 :-. -".
<br />. ....„
<br />.,: . . 7 . = : .: -:.
<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER
<br />I certify under penalty of law that this document and all attachments were
<br />prepar d under my direction or supervision in accordance with a system designed
<br />to assu e 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 />or those persons directly responsible for gathering the information, the information
<br />submitted is, to the best of my knowledge and belief, true, accurate, and complete.
<br />I am aware that there are significant penalties for submitting false information,
<br />including the possibility of tine and imprisonment for knowing violations.
<br />'
<br />."..
<br />TELEPHONE
<br />DATE
<br />'
<br />9 74-i- / /sic
<br />i
<br />0
<br />H fZ_ 3 c-, r- ? e.,
<br />C.-- v .. /:, I AAIFF7
<br />•,...-‹
<br />--- - - "" — .4. ...fl A !L....A P---
<br />s r - ^
<br />SIGNATURE PRINVPA EXECU
<br />OFFICERO, AUTHORIZED AGENT
<br />AREA
<br />CODE
<br />NUMBER
<br />YEAR
<br />MO
<br />DA
<br />TYPED OR PRINTED
<br />PERMITTEE NAME/ADDRESS (Include Facility Name/Location if D)ferent)
<br />NAME
<br />ADDRESS -,;;;.-■.`_:-;; F7.
<br />FACILITY 7 .:
<br />LOCATION
<br />7;0 71.i. E73,-Ti:;".
<br />• r T."":" Nff ",i"" 7,
<br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used.
<br />FROM
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here)
<br />!
<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
<br />DISCHARGE MONITORING REPORT (D R)
<br />PE NUMBER
<br />YEAR
<br />MO
<br />MONITORING PERIOD
<br />DAY
<br />TO
<br />DISCHARGE NUMBER
<br />YEAR
<br />MO
<br />DAY
<br />TC
<br />'II 72;
<br />NOTE: Read Instructions befor co pieting this form.
<br />- . 5.
<br />c7..-", 4 4- .P.Ft)f,9 ,111 .
<br />Form Approved.
<br />OMB No. 2040-000 ,
<br />PAGE OF ,
<br />1
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