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PER1dIT7EE NAhgE:ADC1nES5 .. __,. ~ _ ri.miJDiffrrrnq <br />NAh1E <br />ADDRESS <br />FaclLm <br />LOCATION <br />i) E316'' <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 MO DAY <br />FROM TO <br />Form Approved. <br />OMB Nc. 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 />~ ,• j <br /> MEASUREMENT 1 <br /> PERMIT • <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT ~" ` <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE ! r , <br /> MEASUREMENT <br />f <br />~ - ~- <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 />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I ~ trot. under p•mdh ..(la» thin Ihn d~.nmrnl and all aua<hnrrnl. »rn <br />rr <br />ar d under <br />s dir <br />a'lin <br />o <br />in <br />w <br />rn i <br />in xr <br />dunr <br />»ith a <br />rr <br />m d <br />i <br />r <br />d TELEPHONE DATE <br /> p <br />p <br />m <br />e <br />n <br />r <br />p <br />. <br />n <br />or <br />e <br />. <br />r <br />r. <br />R <br />x <br /> lu mwrr Ihat yuuhrivd (x•r..mnel prnpe rly Rurhrr and rvuluulr 11x• information <br /> suhmillrA. ba.ed nu mr inywr~ of Ihr (x•raon ur (»•rvrm who mnnxRa• Ihr ..dvm. <br /> ur thr»r pennn< dirrrtl~ re.pmsihk !nr RalhrnnR rhr in(urnnlhul. Ihr infonnuliun <br /> +ubmxuvl i.. to Ihr hr.l ..f nn Ano»IedKr anA hrlx•f, trrx•. wcurnr, and cumpkle. <br /> <br />I am u»urr Ihal then• are siRniMunt pcnaltir~ h.r whmittinR fakir information $IGNATU~IE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED OR PRINTED , <br />irxiudinK the (wn.ihilit~ u( fine and impre.onmrnt fur kn..»ing dolauunc. OFFICrbR OR AUTHORIZED AGENT AREA <br />CODE NUMBER <br />YEAR <br />MQ <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />EPA Form 3320-1 (Rev 3/99) Previous editions may be used. Thi. t~ 8 -I-PBR ft>t'nl. PAGE OF <br />