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PERMiTTEE NAM '*,DDRESS (Include NATIONAL POLLUTAI SCHARGE ELIMINATION SYSTEM (NPDI:S) rmApproved <br /> Facdtl,--#Aenff7to rf different) DISCHARG INITORING REPORT (DMR) 1B NO. 2000-0015 <br /> NAME^— + r*e)fjY F�` " T_f__1'_ r (; T '--- - (2- (17-19) <br /> ADDRESS— Lil W!'A 1 tRe————————————— i ` .• ;{-, 1 �I, I t:;, { <br />—^-- r LI HO�,'Ll±.. PERMIT NUMBER DISCHARGE NUMBER <br />— —�—f 1) $i{f�---- — MONITORING PERIOD <br /> FQ9,ILM—^---- —————— YEAR I MO I DAY YEAR MO DAY <br /> LOCATION -_ FROM Q' I! t TO 116 Q Z <br />-- ——————— -- <br /> 00-JI) 1,21-21) 124.13) (2e-27) (18.29) (10.31) NOTE: Read Instructions before completing this form. <br /> (3 Card Only) QUANTITY OR LOADING (4 Card Only) QUALITY OR CONCENTRATION <br /> PARAMETER (46-53) (54-61) (38-45) (46-53) (54-61) NO• FREQUENCY SAMPLE <br /> of <br /> (32-37) EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS (62-63) (64-M) (69-70) <br /> SAMPLE <br /> C MEASUREMENT <br /> F � {a�+ �F }"f {.{{� Ai ( � • � 4 w is , e a A t• , r, <br /> PERMIT <br /> r/ 1� REQUIREMENT + . , # ! a ♦ r s <br /> SAMPLE <br /> SULJ 1` ; 11)T fii, ',ilj';� MEASUREMENT *-..^.... r <br /> n n r n REQUIREMENT a A <br /> SAMPLE <br /> {(fit? TO I Al MEASUREMENT ' F <br /> F PERMIT <br /> ,1 t� REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ..,.,- <br /> h REQUIREMENT <br /> SAMPLE ) <br /> r <br /> MEASUREMENT <br /> PERMIT <br /> r i)It f! REQUIREMENT <br /> SAMPLE <br /> r (,1i 001 1 1 V J T lr MEASUREMENT <br /> T ) PERMIT <br /> 7 REQViRgMBNT a t a r 1 r x y * y w r + �j:•- a I } ., , <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> ttBQU I REM ENT <br /> NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY EXAMINED TELEPHONE D A T E <br /> AND AM FAMILIAR WITH THE INFORMATION SUBMITTED HEREIN AND BASED •` , <br /> p ON MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY RESPONSIBLE FOR `•.� v <br /> • t I!f l:.' s OBTAINING THE INFORMATION 1 BELIEVE THE SUBMITTED INFORMATION 1 <br /> ry IS TRUE, ACCURATE AND COMPLETE I AM AWARE THAT THERE ARE SIG �; I) -•)�^, i) o,I <br /> NIFICANT PENALTIES FOR SUBMITTING FALSE INFORMATION. INCLUDING <br /> THE POSSIBILITY OF FINE AND IMPRISONMENT SEE 18 USC § 1001 AND SIGNATURE OF PRINCIPAL EXECUTIVE <br /> 33 US §1319 (Penalties under these statutes may Include fairs up to f10.000 <br /> TYPED OR PRINTED and/or maximum imprisonment ofhetween6 months and 5years) OFFICER OR AUTHORIZED AGENT 's` A NUMBER YEAR MO DAY <br /> ICODE <br /> COMMENT AND EXPLANATION OF ANY VIOLATIONS (Reference all atrachntents here) <br /> } F 'It) lil :i(.l!j:'.r{r} f)(,('t'� 1'f I' 1 'II I � c t i r � � f'1t� 1 " I I I .• I I <br />'} (I,t !' i; .+111t Y j Y j 1 Y � /I • i I I � t l r I I ! � ! i'} 1 i F B I I . I _ <br /> I <br /> A Form 3320-1 (Rev. 10-79) PREVIOUS EDITION TO BE USED (REPLACES EPA FORM T-40 WHICH MAY NOT BE USED.) PAGE OF <br /> UNTIL SUPPLY IS VVMAIIQTFn <br />