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PERMITTEE NAME/ADDRESS 1ncGak fai ilrn \'amdlrtcanrrn if lhffrrreu <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <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 />rl . <br />t; <br />F <br />I~ <br />Form Approved. <br />oMB No. 2oao-oooa <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION rtQ• FREQUENCY <br />OF SAMPLE <br /> EX Y <br />I TYPE <br /> ANAL <br />S <br />S <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE ~ ~ <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE ti F' <br /> MEASUREMENT <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 /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />NAMElTITLE PRINCIPAL EXECUTIVE OFFICER I cerur~ tinder Ix•n:dq ..t law wat mi. d«nnx•m and au att:Nhmeats were TELEPHONE DATE <br />prepur vl unJcr m~ Airection r~r +utx•r. i.inn is uccurJnncc with a ydrm Jr.r>rncJ <br />to uuure that yualifird {w•r+ouncl pt operh guthrr amt r. abate the information <br />.uhmiutvl. H»+ed on m~ inyuir. rd the Arnow or pa•rwn+ who manaCr thr y+trm. <br />' <br />ur thov prtamc direrll~ re+q m+ihk for Qatherint; the information, the information ~ ~ <br />whmitlrA i+, d, lhr IK•_a of my Anowlydpr and Ixlkf. True. accurate, and rnmplMe. <br />SIGNATURE OF PRINCIPAL EXECUTIVE -• <br />~ <br /> I am aware That Ihc•re urr.iknificmrt penultir+for+uhmiuin>• fats information. ARE <br /> <br />TYPED OR PRINTED iweludinR thr it dih of fine and im rn nmem for Lnowin i Wuon+. <br />p'^+ ' P ~ "' OFFICER OR AUTHORIZED AGENT DE NUMBER YEAR MQ DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Re/erence all attachments here) <br />EPA Form .3320-1 (Rev 3'a? F''=;i.na •:.t:n; n,:, C- .s _ I ~ll~ I~ ;I 1-1i[IIi It~!!t! PAGE OF <br />