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PERMITTEE NAME/ADDRESS ilnrhulr Furilitp.\'amdLuratinn iflHJfrrrnp <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES) <br />DISCHARGE MONITORING REPORT (D R) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />form Approved. <br />_ OMB No. 2040.0004 <br />f1I' '` <br />F - F 1 NIL. DEt <br />C^t31_ atTi~f~AGF. T•r_? UN!~It4±'"EFO D 1 T;;H <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION N0. <br /> <br />EX FREQUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT ~ ;• I ' ~ . r, rA t <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 />NAMElTRLE PRINCIPAL EXECUTIVE OFFICER I certif. under penalty ..t mw [hat thin document and all etwchmenrs were <br />rr <br />nrrd under me dinr~tinn nr.u <br />en-i+i~~n in utt~ordunce with u sratem da,i <br />nrd TELEPHONE DATE <br />_ <br />I <br />I <br />. - p <br />p <br />p <br />g <br />to a~ ore that yualitied pervmnrl prnperl~ pother and ca aluate tlrc infunnati~m •~ ~ <br />~ <br />~ <br />• <br /> aubmiued. Based on m~ inquire ~><the parum nr perwm. who mnwpe the epgem. ~ <br />' or lhav prnuro din 'tl. rap~naiMe !nr pulhrrinp the inforrnaliun. the information <br /> <br />~ ' suhmitted fa, to the heat of nn hnuwledpe and Irclief, true, accurutr, and complete <br /> <br />I am awan• tb»t there an• ai <br />ni~rnnt <br />enalties for auhmitlin <br />falx• informati <br />n <br />SIGNATUREAF PR{NCIPAL EXECUTIVE 7 r ~ ~ ' <br /> <br />TYPED OR PRINTED p <br />p <br />p <br />. <br />o <br />including tha• poeaihilih rrf fine and impriw.nmrnt for Anowinp ai~datione <br />OFFICER OR AkITHORIZED AGENT AREA <br />C D NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. "-'`7`} This is a ~-part firm. <br />