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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 />ilf.';', -; : 1: - . - r•
<br />- :":• - : - Y- 1 t".: " ,-. '„, —■:!. ,, ; 1 .'.} •.
<br />SAMPLE
<br />MEASUREMENT
<br />'..,-,=: ':,
<br />' :-
<br />- ' ..
<br />. .. PERMIT .
<br />REQUIREM
<br />:, --. .:. -a-
<br />, -v- •
<br />, ,
<br />i ..p..i•I NI.„:
<br />"1. ' .r. i' Ji\''l
<br />';''.' :::-,....• .::
<br />.-2. :- " .: '.:-.; 1.7 5 7.3 ' .,; ,.. ,
<br />SAMPLE
<br />MEASUREMENT
<br />** t
<br />-14 0' -,1.r -*-:-:- .:-
<br />....:,.417
<br />,:".-;
<br />• : '
<br />•• :::.. :PERMIT ...... ::
<br />..... . :.. .
<br />. REQUIREMENT
<br />- •:,..-:' -
<br />0: ,- , -,, :. f-
<br />:i7.:..:.''' '.'.• , —. ..' ,1 1- . :1
<br />- , ' '''.. ' = •" ' ' ' '
<br />•
<br />SAMPLE
<br />MEASUREMENT
<br />. : •:, '1 -.: .,":.
<br />. .
<br />' ,',:::: - • ..)5 'T
<br />1
<br />•,n•a:•, '.4 ! . :
<br />7 : : ,....: ; i ',.•, :
<br />PERMIT .: .:
<br />REQUIREMENT
<br />-.,. .",„ i;-:. .-4
<br />SAMPLE
<br />MEASUREMENT
<br />:.-
<br />_ 'if:::
<br />,,,„", 7... '.;
<br />'•
<br />I': ''..,,-; `,-;',
<br />.1”- > '
<br />: ,.. : ... ...
<br />... :.:.:.PERMIT.:. .'::
<br />'REQUIREMENT:
<br />-":-:::- 7 -- ; 0
<br />S '7 .7
<br />:::: "..'",2 '; - :, - • '
<br />- :-.i
<br />SAMPLE
<br />MEASUREMENT
<br />::-•-. -i 1 7•.: -:,
<br />%,.; •
<br />•t;.:
<br />'./;•..' r
<br />• 1{.•,71;.)'s, ir.-'"
<br />; ''..K ',
<br />::.; `,''''', .; ; ... "1 .- 4
<br />.:•::- PERMIT .: ;
<br />. ..... .. ...
<br />REQUIREMENT.
<br />... , .-- ' :: .,,,,
<br />, , .
<br />*0, -,:4-: 4 ',' ...;-
<br />"jE.r.
<br />\":t.2?"' '''''■
<br />:::.,V : "..
<br />',.', 1 ".; L ::' ': ,
<br />. ..,;,,..*, I, ,t, _le
<br />SAMPLE
<br />MEASUREMENT
<br />if- -If 3;
<br />, I. !..4
<br />.•.; i-:: =.1:-"- 3:-
<br />„ ,',"._, :'
<br />7 • * : .
<br />'1
<br />***?
<br />1 0
<br />. 's C.- ,.),,-:' t:.. * -' ':
<br />P 7..
<br />;.''',:. :, '... '1' vi
<br />:::-..:..:•. PERMIT . .•
<br />RECty REMENT:
<br />.. -1 . .-1:". -*-- 11.
<br />: •:-- . -::"t.1 '
<br />: .' i' '-:
<br />:
<br />"" ,'... '..,...-.--:. - :-':.- ,...,;,.? .. a ., ; •,:., '‘ ..,, , ', - REQUIREM E NT :.
<br />SAMPLE
<br />MEASUREMENT
<br />.--;..
<br />-..- .: "," - 0 .:,".
<br />----N1
<br />F : ' ': ';'' ,.;',',
<br />•••••:......PERMIT -
<br />- ' -
<br />,,..
<br />ir, I .- .; .1,.::-
<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER
<br />'certify under penalty of law that this document and all attachm nts were
<br />prepared under my direction 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 />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 fine and imprisonment for knowing violations.
<br />.
<br />.....-s— /
<br />( ' s ,
<br />.2.-* -----::-..... .‘,
<br />1
<br />TELEPHONE
<br />DATE
<br />0
<br />("1_
<br />r
<br />0
<br />l k . -t -- 0 ■,;11?
<br />----ki
<br />kl (o rr,
<br />SIGNATURE OF PRINCIONL EXecliTIVE - <: - .. , CS
<br />QFFICER,.04 AUTHORIZED AGENT
<br />AREA
<br />NUMBER
<br />YEAR
<br />MO
<br />DAY
<br />TYPED OR PRINTED
<br />PERMITTEE NAME/ADDRESS (Include Facility Natne/Location if Different)
<br />ADDRESS ;]"•
<br />.17(;
<br />FACILITY 7 .
<br />LOCATION
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here)
<br />EPA Form 3320 (Rev. 3/99) Previous editions may be used.
<br />FROM
<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
<br />DISCHARGE MONITORING REPORT (D R)
<br />PERMIT NUMBER
<br />YEAR
<br />MO
<br />MONITORING PERIOD
<br />DAY
<br />TO
<br />DISCHARGE NUMBER
<br />YEAR
<br />MO
<br />DAY
<br />a .4-pu
<br />Form Approved.
<br />OMB No. 2040-0004
<br />NOTE: Read Instructions before completing this form.
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