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PERMITTEE NAMEIADDRESS (!nclude Facility Namdlocanon i/D~ercnq
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<br />NATIONAL POLLUTANT DISCHARGE EDMINATION SYSTEM (NPDES)
<br />DISCHARGE MONITORING REPORT (OMR)
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<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
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<br />Form Approved.
<br />OMB No. 2040-0004
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<br />NOTE: `Read Instruclions~before~ pleting this form.
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<br /> QUANTITY OR LOADING QUANTITY OR CONCENTRATION NO. FREQUENC SAMPLE
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<br />PARAMETER AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ~~~ls
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<br />SIGNATURE OF PRINCIPAL E%ECUTIVE
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<br />inclutlin the ossibili olfne and lm risonmenl for knows swlations. OFFICER OR AUTHORIZED AGENT NUMBER YEAR MO DAY
<br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Releronce all attachments here)
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<br />EPA Form 3320-1 (REV 3/99)'"Previ6us e~lioris~may be used. D'l 5 0 T / J ~v' 71 I ~S`IS A 4,~PART FORM PAGE OF
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