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PERMITTEE NAME/ADDRESS t/nrluAe Fariliry .~umr/l.~kuriun if IAJftrrnn <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 />~1 <br />~r <br />F <br />Form Approved. <br />OMB No. 2040-0004 - <br />NOTE: Read Instructions before completing this form. <br /> <br />PARAMETER <br />QUANTITY OR LOADING <br />QUALITY OR CONCENTRATION NO. <br /> <br />EX FREQUENCY <br />Op <br />ANALYSIS SAMPLE <br /> <br />TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />ASUREMENT !, ~' <br /> ME <br /> PERMIT <br />flEQUIREMENT <br /> SAMPLE <br />ASUREMENT <br /> ME <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br />ASUREMENT <br /> ME <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 /> <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br />MEASUREMENT <br /> <br /> PERMIT <br />REQUIREMENT <br />NAMElfITLE PRINCIPAL EXECUTIVE OFFICER I .''rtil` unJrr prnnln ~J tun that uri+dwcumem aml all ottacltmenn Here <br />prrpared nnJrr m~ dirxr•tion nr +upen~i+i~m in amirdanee with v s~+trm de+iKned TELEPHONE DATE <br /> to ~.+urc that ymdiried personnel pngw•rh father and eraluntr the infnrmnlinn <br />+uhmiLLrd. Fia+ed un my inquire of thr perrnn or prr+on+ who mana);r the +7+tem, <br />mrihlc fur >;athrrint: thr infornwtiun. the inrurmution <br />ih r <br />di <br />~ ~+ <br /> ra <br />c+lw <br />ur lhu+e pcnnn+ <br />whmitted cc. to the be+t of my Anowlydt;c and Iw•licr. true, wrror tc. and cnmplrtr' $IGNATUR~ OF PRINCIPAL EXECUTIVE I <br /> I am aware that there are +ittniricant prnoltic+ hir whmiuin>t futce inG•rnmlion• QFFICER OR AUTHORIZED AGENT AREA NUMBER YEAR MO DAY <br />TYPED OR PRINTED in<htdin~ the pre+Ibilin or 6nc and imprionnrrm for Anwwin¢+idatlon+. DE <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Re-erence all arracnmenrs nere~ <br />Previous editions ma be used. ~I 1iI~ I~ :i ~-harl ittnu. <br />EPA Form 3320.1 IRev, 3991 Y <br />