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PERMITTEE NAME/ADDRESS (7mollt k arrhryN..dLoc.rien 1JO?e«r) (?`? OATIONAL POLLUTANT OISCHMOE ELIMINATION SYSTEM (NPDES) For NopMgaa <br />NAME 0 DISCHARGE MONITORING REPORT IDMR) OMB ADDRESS 4F/ <br />PERMIT NUMBER DISCHARGE NUMBER F l NAL - - <br />%TE WET r =;;T I NG FOR 001A <br />a <br />FACILITY Z m --I. ;r lOC O MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />LOCATION ?ERSE'^ FROM TO <br />,RISE; E. $) ARC PRES? lr . Q NOTE: Read Irmtructiorw before complstinp this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> <br />E OF <br />Y <br /> X ANALYSIS T <br />PE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ;. tr <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT F <br />1 eerttly under pens ly o I.w lhal N6 doevmenl and eU .Il.chments were <br />TELEPHONE <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER <br />DATE <br />prepared under my direction or sup.r.fston In aceord.rwe with • system deigned <br />to sears that qualified personnel properly g.lher and eeahrale the Information <br />submitted. Bred on mr Inquiry of the person or persom who manage the system, } <br />or (hose person directly reponolble for gathering the Informallo, the information <br />tubml.led I& to the bet a my knowledge and belle!, trite, atavrate. and compkte. - <br />19. aware that then are slgdlkant penaltles For robrrdtrtn <br />fain Inro <br />SIGNATURE OF PRINCWAL EXECUTIVE - --? <br />d - ?, <br /> g <br />rma <br />oet, AREA <br />TYPED OR PRINTED Indud(ng the paadbttlly or fine and (mprlrnment for knowing elolsoorm OFFICER OR ALITHORIZED AGENT ODE NUMBER <br />C YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference aM attachments hors! <br />F)RT LC50 - STATISTICAL POINT ESTIMATE WH <br />_ JTY TEST REPORT FORM TO n-flR. <br />EPA Form 3320.1 (Rev. 3199) Previous editions may be used. This