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PERMITTEE NAMElADDRESS Unrfudr ForiGrr A'arar/tncariun iJIK,Oirnu <br />NAME •- <br />ADDRESS ' ~' = ~ ~ ~ - <br />a~~ <br />,~ <br />FACILITY Z~~ P11Nar <br />LOCATION G ~ ~ ~ ,~. <br />E WkDE. M 1 "dE FifaPdRGER <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES) <br />DISCHARGE MONITORING REPORT (D R) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEA MO DAY <br />FROM TO <br />Form Approved. <br />OMB No. 2040-0004 <br />In~zKs ~ <br />--` <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION N0. FREQUENCY SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE ' <br /> MEASUREMENT <br /> PERMIT '- <br /> REQUIREMENT i•1 T I 1 ` nz l `;"~ "'r : a ; " ;; <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ . ... .. _, <br /> REQUIREMENT • . , , ,',',: G-' s 9:~. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT o :: - ,. ~ _ . <br /> REQUIREMENT ~ F! i i ~ r;`,: <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT . , _ .: . -. <br /> REQUIREMENT ~ - - ~+ ri~it-~ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT " • ,• . - ' <br /> REQUIREMENT MX .. h„ : _ . <br /> SAMPLE ~ ''~' <br /> MEASUREMENT <br /> PERMIT „ r.. - ~- ..: ., ,. .. - . <br /> REQUIREMENT - ~ - <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - :.. ! c ,-,. , _ - <br /> REQUIREMENT _ . - :, ~~ i ; `; . <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I rrrtir> under prnaitc ~d law that this ducunxm and all atturhmrnt. were <br />s di <br />d <br />d <br />~li <br />i <br />i <br />i TELEPHONE DATE <br /> prepare <br />un <br />er m <br />m <br />on or wperr <br />s <br />un <br />n accordance wiUt r >,>trm dniRnrd <br /> to insure that yualifiad prrwnnrl properly Aalher and rrrluatc the information ~- ---' <br />-- >uhmittrd. lix>rd m nn inyuln ~d the pervort nr perwns who matragr the y~>trm. i ~ 1 <br /> <br />_ <br />~ ur thin" prrxon, dinrU~ restxm>ihk for pathrrink the information, the information ~ ~ i <br /> <br />,. ~.- ~ ~- / <br />submiurd i5, to the txst of m. kttuwh~dRr aml belief. trot, aceurvtr. and aumplrtr. `t' <br />~ ~ _I I' <br />f 1 i •' <br />•~% /% ' <br /> 1 um aware that there ar~>i>Znifk-utt <br />rrultie. for >ubmiUin <br />tlu <br />false info SIGNATURE OF PRINCIPAL EXECUTIVE ,;.,, <br />_ <br /> <br />TYPED 0 PRINTED p <br />k <br />rma <br />a. <br />inaudin~ the gn>ihilit~ of tint and impriwnment fur knowing ai~dutinm, <br />OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />DE <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Re/erence all attachments here) <br />-~~ <br />EPA Form 3320-~ IRev 3.'39j Previous editions may be used. <br />This is a •3-part filrm. <br />