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PERMITTEE NAMEIADDRESS tlntfude Fatilir~ .Ynme.9,ucarion if Uifftrenn NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS <br />PERMIT NUMBER DISCHARGE NUMBER <br />Facllm MONITORING PERIOD <br />LOCATION YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved. <br />OMB No 2040-OOOk <br />t'- <br />~ - F"A .. <br />if[e:!-~t~ <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ• FREQUENCY SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />- •~ <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 />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I .rnif) under pa•nulh nrlaw that thisdocmnrm atwl au atmohment` wen <br />ara•d under m <br />dira"tion ur w <br />rr <br />rni.ion in acs+rdunce with a ..arm dr~i <br />n <br />d <br />~ TELEPHONE DATE <br /> p <br />p <br />. <br />p <br />>; <br />r <br /> p+araurr Ihal yualirird pronnnel pngx•rl~ gatha•r end ranluetr Ihr information <br /> .uhmiutvf. Rx~ed on m~ mquin of the pa•nnn or prawn who mana>;r Ihr c}arm. <br /> nr thaw prnon. dirralM re,pmdbla• for Yuthering Ihr mrormatiun. Iha• informWion , I ~ <br /> submitted i.. h~ the be,t .+f m. Anowledge end brlirf, trua•, ucavrua•. and romplra•. I I I •, <br /> 1 am aware that them an• aignifn-ant prnultin fur whmittmg fal.e information SIGNA URE OF PRINCIPAL EXECUTIVE <br /> , <br />i OFf~ICER OR AUTHORIZED AGENT AREA <br />TYPED OR PRINTED ng Ihr ptncibilih of fine and impria+nntrnt G+r AnlHain~ .iolation,, <br />includ NUMBER <br />CO E YEAR MQ DAY <br />VVMMCIVIJ HIVU CArLnt~r~ttvn yr rnr trrv~e+ttvt~o (nrrr/rrreC au a[taervntrnw nrrC/ <br />EPA Form 3320.1 (Rev. 3-99) Previous editions may be used. -This IS H 4-~tart I~OfItL PAGE OF <br />