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PERMITTEE NAMEJADDRESS dncludr fariGrr .1'amdlorafutn iJUifJaenll <br />NAME <br />ADDRESS <br />FACILITY 4= NO 1 F'A5? ax >,JE.r~T P1 ; N!_~ <br />LOCATION ;, rj ~; j 4c!?i <br />~ N, VP /Gfy <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 />M F fJOF <br />( ~ULiF~ <br />F - F <br />Form Approved. <br />OMB No 2040.0004 <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION ND, <br /> <br />EX FREQUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> pNALVSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />l i <br />~ I <br />~+ ~ <br /> MEASUREMENT I Vl, <br />.- <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 /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I crr/ifi under prrwh) of law that This d~K-ums•nl and nll uttachmrnts wen <br />d <br />i <br />d <br />ith <br />t <br />d <br />di <br />ti <br />i <br />i <br />d <br />d ` <br />~ ~ TELEPHONE DATE <br /> <br />J f f O I~ on or suprrs <br />u c~s <br />em <br />rsq;ne <br />prepurr <br />un <br />er ms <br />rec <br />s <br />on <br />n accor <br />u~scr w <br />to a wre Thal yiwlifird perrvmm•1 prnprrA gather and cc ahwte lhr infarmuLon / <br />', ~ <br /> submithd. Rased on m~ inyu{ry of thr {arson ur pernonc who manage thr c~stem, ~ <br />~ <br />~ <br /> nr Ihncr prr„ms dirertl} raypmsihle fix gathering the information, thr information -~~ .' <br />~ ~ ~ _ <br />~ j j cuhmined is, In thr first of ms Annwirdge and lalirf, Ina, atYUrute, and comtdetr, <br />1 <br />th <br />if <br />t <br />lti <br />itY <br />ti <br />th <br />i <br />f <br />h <br />t <br />b <br />i <br />f SIGNATURE OF PRINCIPAL EXECUTIVE ~ <br /> <br />TYPED OR PRINTED ican <br />pena <br />es <br />or cu <br />m <br />vtg <br />n <br />am aware <br />at <br />ere are s <br />gn <br />u <br />e <br />orma <br />on. <br />inAuding Ihr p~nsihilin of fine and imprisonment for knowing aiohdion,, <br />OFFICER OR AUTHORIZED AGENT AREA <br />CODE NUMBER <br />YEAR <br />MQ <br />DAY <br />COMMENTS AND EXPLANATION OF ANY v10LAlIONS (Heterence atl attacnmenis nere~ <br />PAGE OF <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used 'Fltiti 1S a -1-part form. <br />