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PERMITTEE NAME/ADDRESS tlnrludt Fanlin• .VamdLutarinn rJlbJfrrrnd NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS <br />PERMIT NUMBER DISCHARGE NUMBER <br />FACILITY MONITORING PERIOD <br />LOCATION YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved. <br />OMB No 2040-0004 <br /> <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, <br /> <br />EX FREQUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <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 /> SAMPLE <br /> MEASUREMENT ' <br /> <br />PERMIT , <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT '-• <br /> PERMIT <br /> REQUIREMENT ~ ~'~- <br /> SAMPLE <br /> MEASUREMENT L <br /> PERMIT . <br /> REQUIREMENT ' ` <br /> SAMPLE <br />` <br /> MEASUREMENT - <br /> PERMIT ~ ~ '~ <br /> REQUIREMENT , <br />NAMEITITLEPRINCIPALEXECUTIVEOFFICER I,r,t,r'•""nrrr,rn~h~orh„mallhi,daKUmm~ta"dxllarLChmrnuwrre <br />rr <br />:urd under m <br />dinaliun nr w <br />rni.iu" in :n'a•ontuna~ whh a <br />41rm drai <br />nrd TELEPHONE DATE <br /> p <br />p <br />~ <br />p <br />y <br />g <br /> to axurc that ywlifi.d {ta•ttiunnrl pn,{x•rh ¢alhc, and r, ulualr IM~ inG.nnat{on -_ ~ <br /> cubmilud. Rased on m) inyuin of the {xru,n or {x•r.onc .. ha, m:mage the y.lem, ~ <br /> "r Ihuu {x~r~.,ns dim 11. rr.p,n~ihlr for lalherin4 the infnrmaliun. Iha• infnrinulinn <br /> suhmitlaa1 i.. 1.. the M+t of nn Annwlyd,r :md Ik•lirf. Iruc. aa~a~ural.~, end aomplrte. <br />I arn:,,,ar~~ d, <br />n Il,rr,~ <br />,n~.i~~mr,:u,t <br />H„ <br />drn-, L.r .u~~nunn,p r <br />d.e ~"r.~rn,:,u.,n <br />~ SIGNA URE OF PRINCIPAL EXECUTIVE i <br />a <br />TYPED OR PRINTED . <br />{ <br />. <br />. <br />. <br />. <br />ua~u~Iin; ~~~, Iv•.~l.Bin ~•~ tio, .u~d h,~pn•~.,nnrut 1„i Lro•~.wc ~i~dati~un. OF~ICER OR AUTHORIZED AGENT AREA NUMBER <br />CCDE YEAkt •MO DAY <br />GUMMtNTS ANU tArLranialwrv yr ruvT VIVLAIIVIVJ Irreverence an arracnmencs Here/ <br />EPA Form 3320.1 (Rev. 3/99) Prewtws editions may be used. Th'r. i~ a 4 <br />