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PERMITTEE NAME/ADDRESS Ilnrfud~ Fatilin Samr~li:cminn if lliffrrrmi NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />NAME <br />ADDRESS <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />FACILITY YEAR MO DAY YEAR MO DAY <br />LOCATION FROM TO <br />Form Approve:yt <br />OMB No. 20a~,•000x <br />Kt <br />NOTE: Read Instructions before completing this form. <br /> <br /> <br />PARAMETER <br />QUANT <br />ITY OR LOADING <br />Q <br />UALITY OR CONC <br />ENTRATION NO. <br /> <br />EX FREQUENCY <br />pF <br />pNpLySIS SAMPLE <br /> <br />TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE i ( 1 <br />` ~. _1 <br /> MEASUREMENT ~ ` ~ <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />t <br /> MEASUREMENT ~ <br /> <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 />~ I <br />~ ~ <br />' <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />MEASUREMENT <br />~ "~` I•' <br /> <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br />CIPAL EXECUTIVE OFFICER I .ertir> under penally of mw ww mih d~wuma•nt and ~u unuehment. werr <br />~ TELEPHONE DATE <br />NAME/TITLE PRIN prepnr •d under m~ dinrtinn ur wpa•r~i+iun in :ai~~~rdauce eith a +yctem dr+ignad \ <br />~ <br />D[~/S^~' <br />vv ~~ ~~ d. u++un• Thal gwdiricd In•r+:mnd prnprrh kalhee arul e~:duale the infoemuriua ~ \~ <br />I wbmillyd. Hued un m~ inyuin of the per'+~m :•r perwn. whu manaac the +~+:em. <br />~ <br />' ~ ff <br />~ <br /> mn.iMe fur k:dherinq the inlurmatiun. thr infurmutian <br />n•+ <br />• <br />n <br />+di <br />n'll <br />W ' <br />~ - 1 <br />~~ff I <br />nr <br />:.+e <br />pe <br />nn <br />r <br />~ ! i I <br />••')' _r Y <br />~ ~ <br />r whmithd h. lu UK Lr+t or me Anuwied¢e :md hrlieL trur, acrurrlc. and annplele. SIGNATURE OF PRINCIPAL EXECUTIVE <br />47 <br />JJJ 1 <br />'~ I :un aware rhm there are +i~nifi~aN ycnullie+G~r whmiuink ral+e inrurmarhwr• OFFICER OR AUTk(ORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MQ <br />DAY <br />TYPED OR PRINTED indudiny the p:n+ihilil~ nr fine and impri+nnment fur knnwin>; :i~~IntionM1• D <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />~liti fti' 0 -~-I)art f(~rtll. PAGE OF <br />EPA Form 3320-1 (Rev. 3199) Previous editlorts may tie used <br />