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PERMITTEE NAME/ADDRESS:-nrluAr Futilih \nme/l~ation iJfN,Qerenll <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />t;~J t3Sti.5 <br />M,0.r.lAf;Fi~t <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERI00 <br />YEAR MO OAY YEAR MO DAY <br />FROM TO <br />Form Approved <br />OMB No. 2040-0004 - <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY <br />OF SAMPLE <br /> EX ANALYSIS TYPE <br /> <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> <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 <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />NAMElTITLE PRINCIPAL EXECUTIVE OFFICER I crnit> under q•nalq of lu.+ Ihul +hi. J~wumcnt and all uttachnwnt. ++rrr TELEPHONE DATE <br />prrprreA under nn dir+rtiun nr wprn ision in acrnr<Imirc w ilh n +++trm Je++gned <br />to n++ure that yunlifirJ pcr+onnrl pn.p+•ri. Y.dher unJ ewluua• the information <br />+ubmitlrJ. liuud on nn inynin of the person ur prrwnc Hhn n+unuge the +>+Iem. <br />nr th~nr prrv~m dinrtl~ n p+nnihlr for gathrrinY the infurmulion. the infonnatinn <br />nd a <br />ktr <br />li <br />a <br />at <br />m <br />f <br />r. a <br />. trur. xrr <br />r <br />~ <br />p <br />+uhmiurd i.. ~o thr I+r>t ..f m. knoulydge.+nrl M <br />e <br />. SIGNATURE OF PRINCIPAL EXECUTIVE <br /> I um nware thus them urr.iitndcant penulti+r for+ubmiuing false information, T AREA <br /> risonment for Aunuing uolati..ns <br />f fi <br />anJ im <br />th <br />w <br />ibilfn <br />i <br />l <br />di OFFICER OA AUTHORIZED AGEN C E NUMBER YEAR MO DAY <br />TYPED OR PRINTED , <br />p <br />ng <br />r t <br />os <br />o <br />ne <br />nc <br />u <br />1 COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />EPA Form 3320-1 (Rev. 3199) Previous erLtitxls may be used <br />QC Tltt~ Iti a 4-part ff\rm. <br />