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PERMITTEE NAME/ADDRESS tlrrdudr Fatilir} ~'amr/!nt'atcm :/ Ui~frrutt <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />~:O r9..~3 <br />I"IA^dAG~•R <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR O 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 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 ~ ' <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 />NAMElTITLE PRINCIPAL EXECUTIVE OFFICER I n•rtif) under prnulh of law Iha ihi+Arxumrnt and nil ailarhmrnt+ wrrr <br />prrpmrA under nn dirn~tion ur wixn i+iun in :xrurdnn.e with a yHrm draigneA TELEPHONE DATE <br /> to ~. lire that yuulifi+d prnunnel pnyx•rl~ guthrr and r+alu:Ut rtk information <br /> +uhntillyd. 8ux•d un m+ inquiry ..f thr prnnn nr prrwrn. who managr thr cr+icm. <br /> nr thu.e prr~m+dircYtty re~m+iMr for g:ulx•rin¢ the infnrmaGmr. thr infornwtiun <br /> +uhmillnl i+, 4. ihr M•+t of m+ 6nuwleAS;r anA IxJirf. tnre, orrur tr, :md r~wnfdrtr. <br />I am uwarr thin there arc ciKnificnnl <br />enrltirc fnr .ubmilting fal.r infonnatiutt <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br /> p OFFICER Oil AUTHORIZED AGENT AREA <br />TYPED OR PRINTED including Ihr fxr.tihilih of nnr and impriannnmul fur 4nowing +irAatirm.. NUMBER <br />CODE YEAR MQ DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Re/erence all attachments here) <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. 001 •' This'-T~: a =t-curt f~nn. <br />