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PERMITTEE NAMEIADDRESS ilnduJr (arrlite \nutr7•aatiun it Uil/rrnu; NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDE$) <br />NAME DISCHARGE MONITORING REPORT (DMRJ <br />ADDRESS <br />PERMIT NUMBER DISCHARGE NUMBER <br />FACILITY MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />LOCATION FROM TO <br />Form Approved <br />OMB No. 2040-6004 <br /> <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ• FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE t ~ / k~i <br /> MEASUREMENT ~ 1 • <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />~ti <br />I 1 <br />I <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <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 />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER t cena~ ~~~~dr~ gn:,in ..r lar that lhi, d~KUntcnt and all athu•hmenh wrm TELEPHONE DATE <br />prepared under m> dirra•Iion or wpen~i.ion in accordance ailh a ,~,trm dr,ignavl - . <br />t~~ a;;urr that qualified q•re.nna•I pngirrl~ Rather aml e; uluatc the inG~rmation , <br />.ubmiued. Bard rm m~ inytiln of the q~r,rrn or pcrwnt, who manuGe tta• y;trm. / ~ ~~ <br />h <br />f <br />i <br />`-- <br />on <br />e in <br />nnnat <br />or tha,r prrvm, dirae~tl~ n•+gm,ihlr /nr gatha•rin4 the information, t ~ <br />whmittnl n. Iu the br,t u(m~ Anoukdkr and helk/.true, accurnta•, and amtplrtr. <br />SIGNATURE OF PRINCIPAL EXECUTIVE ~ <br />--' <br /> 1 am aware That there are,i~nificunt q•nalua•, rnr;uhmiuinti (akc information. ARE <br /> rnnnmrm /or knm.ing vi~dvti~m,. <br />o;;ihilin of fine and im <br />i <br />ti <br />th <br />h OFFICER OR AUTHORIZED AGENT E NUMBER YEAR MQ DAY <br />TYPED OR PRINTED p <br />nr <br />u <br />nk <br />e p D <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference al! attachments nere~ <br />}EST A RERSONAi3LE PLTFWfIAL ANALYSIS HF-: <br />EPA Form 3320•t (Rev. 3~~=~~~~ P~e••~,~::~~s ea,nons may be ~s~•~ <br />