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PARAMETER <br />QUANTITY OR LOADING <br />QUALITY OR CONCENTRATION • <br />_ <br />NO, <br />EX <br />• <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 />f iE PHAL :'::: S C ! -- RC'N I C <br />,":F' ` Ca.FJMi t t .�f`d._UW <br />SAMPLE <br />MEASUREMENT <br />.. 3 <br />:•iye; -K.. <br />. id• K <br />:E-%rii <br />.7*** '*;c <br />it - A.....' i <br />4 �`.':a't <br />PERMIT <br />REQUIREMENT <br />,. :F,;.tc <br />• r:._ <br />? + x .� d ! <br />l': _.i <br />u . <br />r ai =. •t,• °. r <br />.lid',` DF• :i, <br />( Vii:" <br />-•- <br />SAMPLE <br />MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />SAMPLE <br />MEASUREMENT <br />w <br />PERMIT <br />REQUIREMENT <br />_ <br />.1 <br />SAMPLE <br />MEASUREMENT <br />r• <br />PERMIT <br />REQUIREMENT <br />SAMPLE <br />MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />SAMPLE <br />MEASUREMENT <br />- <br />PERMIT <br />REQUIREMENT <br />SAMPLE <br />MEASUREMENT <br />• <br />• <br />PERMIT <br />REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER <br />I certify under penalty of law that this document and all attachments 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. submitted. Based on 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 />�^�f : ' <br />TELEPHONE <br />DATE <br />-7 f' �t ( + „ y - t� /' + 5 <br />6 1� l/ . ( tt l (, , <br />,. 1‘..1 <br />f ' C -1 <br />" <br />° / r _ k ( y 1 C ' <br />` <br />' <br />. <br />..-tk k: C \,..."....,. ? <br />SIGNATURE'OF PRINCIPAL EXECUTIVE <br />OFFICER OR AUTHORIZED AGENT <br />TYPED OR PRINTED <br />AREA <br />CODE <br />NUMBER <br />YEAR <br />MO <br />DAY <br />PERMITTEE NAME /ADDRESS (Include Facility Name /Location if Differen <br />NAME t :. >4, <br />ADDRESS i t':k .: (i4:i r3 <br />t.. <br />(:^4 <br />FACILITY FACILITY j F •. <br />LOCATIONC.V3 r,'t r <br />: ' ;l. . r — <br />EPA Form 3320 -1 (Rev. 3/99) Previous editions may be used. <br />FROM <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) T. ;\.1=1R <br />PERMIT NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY <br />YEAR <br />MQ, <br />1r r <br />D AY <br />.t•. <br />TO <br />DISCHARGE NUMBER <br />ererence an aaacn men ts nere <br />SUP R Dial s <br />W !•1'i e O 1 .I. c R' C .7 T E'.:;..t'" }! G OR 001A <br />NO 57SCHAR9 ., <br />Form Approved. 4 <br />OMB No. 2040 -0004 <br />C� ' dC3'FTHisU " 4=5.ftform. <br />NOTE: Read Instructions before completing this form. <br />c 't :t;i ., _` ila } v Ad § r { r,. / S' ' 1'"` WHICH �T� 1 - 5i , . .. .:r-. <br />- - ... t. :� OF TEE , � �v�".)(:��a,3U� �. a �': L�.3lu�.... �" .y tt 1�,�3- ��.1;t�, :.t ,•+t''�.� :1:�;t�..,t...`�' .. zt:• �; :i• �:�'�.i' l» <br />erf G': T1._ r & O `•" #: "P". i1 t"('Ac.0 C -RON -O;Z TEST RP"( TO DMR. <br />PAGE s; OF f <br />