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PERMITTEE NAME/ADDRESS ~In~lude Ferdin 1'amr/Inruliun iJDiJJerenu <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION , 3'r <br />, t,:~.R <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 />Form Approved. <br />OMB No. 2040-0004- <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION n1O_ FREQUENCY <br />OF SAMPLE <br /> EX 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 />. <br /> , <br /> MEASUREMENT ' <br /> <br /> PERMIT <br />REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I mrtih under penull~ of ww mat mi. drKVmrm and au wmchment+ wrn• TELEPHONE DATE <br /> prepamd order m. rlirrvtirm or .uq•r+ision in aceonlanrr with a ++:Ycm dr+ittned <br /> to a+em• that yuelifird q•nnnnrl prvgw rl~ tCntlrer and c+uluutc Ihr information <br /> whmitted. Ffwrd on my inyuin of the pr•rsnn nr q•nnn. who mamtye the y+trm, <br /> ur th~rr prrsonc directh mgrmiMe for RatherinC the information. the information <br /> wbmiurd k, to thr M•+t ..r nn MmtdedAe and Ix•hcf. tnk, accurate. and rntnplrtc $IGNAtURE OF PRINCIPAL EXECUTIVE <br />• <br /> I am uwarr that lherc arr +i>;nificant penaltir. Grr .uhntitGnt; fuhr infnrmalha4 <br />A <br />i <br />i <br />ti <br />A <br />l OFF CER OR AUTHORIZED AGENT AREA <br />NUMBER YEAR MO DAY <br />TYPED OR PRINTED :m.. <br />nnw <br />n~ + <br />o <br />ira•IudinR lhr Iwr+tiibihH of fine an <br />impriamnxnt G:r <br />u UE <br />COMMENTS AND EXPLANATION OF ANY <br />(Reference all attachments here) <br />EPA Form 3320-' cFrv _, ~~ Fr,,,..s ea:,,;;,,s ma _- ~hi~ I, a ! I~:frt fnrl7l. <br />