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PERMITTEE NAME/ADDRESS (!nclude Faclllry NamrJlocaion ijDi$erenQ
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<br />NATIONAL POLLIR'AM DISCHARGE ELIMINATION SYSTEM MPDES)
<br />DISCHARGE MONITORING REPORT (DMR)
<br />PERMIT NUMBER DISCHARGE NUMBER
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<br />Form Approved.
<br />OMB No. 2040-0004
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<br />FACiuTY
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<br />l am exam Nffi Ntxe ere signRCant penalties br cubmirong lffise lnbrmatlon,
<br />TYPED OR PRINTED Inclutlin Ne sibili of fine antl im risonment br knowin violations. OFFICER OR AUTHORIZED AGENT NUMBER YEAR MO DAY
<br />COMMENTS AND F>(PLANATION OF ANY VIOLATIONS (Relerence all attachments here)
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<br />EPA Form 332~T (REV 3/ 9 Previous a rtions may be used. ~ ~ ~ ~ ~ / ~ ~ ~ ~ ~ ~ ~ ~ - ~ T~iIS ISA 4-PART FORM PAGE OF
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