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Form Approved. <br />PERMITTEE NAMEIADDRESS Nncludt Facility .~'amdlucation ijfh%jnenU NATIONAL POLWTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) OMB No. 2oao-o00a <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS <br />PERMIT NUMBER DISCHARGE NUMBER ~E~ <br />FACILITY ~, ~ ;•• ~, ~,.~;:;; ; I~ ~ I,, . MONITORING PERIOD <br />LOCATION YEAR MO DAY YEAR MO DAY <br />FROM TO <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ, <br /> <br />EX FREQUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT _ _ ... .. <br /> REQUIREMENT , <br /> SAMPLE <br /> MEASUREMENT r;a~ L <br /> PERMIT <br /> AEOUIREMENT <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 /> PERMt7 <br />REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT _ • .. _ .. _ , <br /> REQUIREMENT 1 ~ ~ <br />NAMElfITLE PRINCIPAL EXECUTIVE OFFICER I certify under penalty of law that this documrnt and all attachments were <br />rtin <br />l u <br />der <br />di <br />o <br />ici <br />d <br />itb u a <br />.i <br />d <br />• <br />i <br />~ <br />t <br />d ~ TELEPHONE DATE <br />_ <br />r <br />.. r _ 1{ G f pn <br />R+nr <br />n <br />mi <br />n <br />r wpen <br />on <br />n +a <br />rnr <br />unce w <br />y+ <br />em <br />um <br />n <br />e <br />to ac+urr that ualifiad rsumtrl ro rly other and evaluate Ihr iofarmution <br />V I+e P Pe g ~ <br />~ <br />~. / / <br />. <br />' <br /> submitted. Bated nn ms inyuin~ of the prr.rm nr pernort who manage the system. 1 <br />~ <br />y. <br />) <br />i LLL <br /> or thovc prnonv din ~tly raprosiblr for kutM•ring the infarmutfon, the infornmtlon _ <br />- <br />' ' ~ +uhmitted in. to the bent of my krmwledga• and belief. true. xrurate. and nunplele. <br />s for <br />1 a <br />uw <br />that the <br />e <br />si <br />lr <br />m <br />e <br />lti <br />b <br />ini <br />fulw i <br />fo <br />ti JJ <br />91GNATURE OF PRINCIPAL EXECUTIVE ~ ~~ <br />TYPED OR PRINTED m <br />arc <br />r <br />arc <br />gn <br />tra <br />p <br />na <br />e <br />w <br />m <br />ng <br />n <br />rma <br />on, <br />including the po+sibilitr of tint and imprkunnxnt for knowin4 siolations. OFFICER OR AUTHORIZED AGENT AREA NUMBER <br />CODE YEAR MQ DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />BEN .~F PR~I <br />EpA Form 3320-t (Rev. 3,'99) Previous editions may be us+ <br />