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P PERMITTEE NAME/ADDRESS Ilnc(udr faciluy 4'amdl~aurios iJ /hfJtrrnt~ <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />~.. tJ C~ J. J J <br />M~iVAG'Er~ <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 YEAR MO DAY <br />FROM TO <br />I'~ I IVY <br />Farm Approved. <br />OMB No. 2040-0004' <br />NOTE: Read Instructions before-completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ• FREQUENCY SAMPLE <br /> OF <br /> EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNRS 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 /> PERMIT <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 />NAMElfITLE PRINCIPAL EXECUTIVE OFFICER I .rrtif~ undrr p•nulry nr law foal mis durttmem atul au anw•nmrnt+ err`• <br />d <br />d <br />di <br />h <br />I TELEPHONE DATE <br /> er m> <br />+n or wfH•ni.inn <br />prrparr <br />un <br />rnl <br />n areord:mre with a+yclrm de+iLnrA <br /> to a.+urr That qualified fx•rsonnrl pmprrl~ gatltrr med r+almtlr Ihr information <br /> +uhmiltnl. Naxd un m) inyuln u( thr tx•nero or pe•non+wha nmewge Iha•.~Hem. <br /> ..r th~nr per.am directh rr+pm+iblr for gal hcring the informaGnn. lhr inGernurtian <br /> whmilted i+, t•. thr Iw~a of m. Lnowlevlge• and hrlirf. true anvratr, and romplrtr. SIGNATURE OF P <br />IN <br />IPA <br />EX <br /> <br />I :un aware Ihul Ihrrr art •ignificunl penahlr+(nr+uhmitling falw information, R <br />C <br />L <br />ECUTIVE <br /> <br />TYPED OR PRINTED <br />including thr pn.ihilih ..f rmr and impri+onment for knowing +urlalion+. OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br /> CODE <br />~!~ <br />r.~ <br />ANU txt'LArvA 1 fun Vr Arv Y v1VLA I IUrvJ tFlererence an anacnmenrs Here) <br />EPA Form 3320-t (Rev- 3+'99) Previous e~ttons may be used- Th(ti Iti a -1-pOtt 1•(~ntl- <br />