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PERMITTEE NAME/ADDRESS Nnrladr futility .\'arnr/lorulion iJbifJomf! <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 />Form Approved. <br />OMB Na. 2040-0004 <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ, FREQUENCY SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - - .. .. - <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br />PERMIT s~ <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 /> <br /> REQUIREMENT <br />NAMEJTITLE PRINCIPAL EXECUTIVE OFFICER I rrrtik under pen:Jh of lux- that this dnrunrem and all mmcbments were <br />d <br />d <br />d <br />a <br />d <br />i <br />d <br />a <br />d TELEPHONE DATE <br />t i _ ~. lrn lion ur suprrvi <br />un in uarur <br />uncr w <br />prrryarr <br />un <br />er nn <br />th u .wem <br />r <br />gne <br />br a<curr that yuulirud per~annel prnperi~ gather and rvaluatr Ihr information '. ' <br />-~ - ~ submitted. Naud on m~ imtuin of the Ixnon ur persrms who manaka• tM system. <br />- or thrrr~ (k•rsom dirrctl~ responsiMr !w gatlu•rin~ the information. the information ' <br /> whmitted is <br />to the beat of my know led);e and tx•Iirf. true <br />aa-cunrtr, and aumplrtr. ' ~~ <br /> . <br />. <br />i <br />1 <br />h <br />M <br />i <br />lf <br />l <br />l <br />f <br />b <br />i <br />l <br />l <br />i <br />G <br />6 SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED OR PRINTED rn <br />~rnrat <br />am aware t <br />at l <br />rr arc s <br />~n <br />icam pena <br />t <br />a <br />ur .u <br />u <br />nE <br />a <br />x <br />n <br />•a <br />includin the w<ibilip of tint and im ra onm~~nt Prt Aro~win i I rti~rtn. <br />K w v a OFFICER OR AUTHORRED AGENT ARpE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />EPA Form 3320-1 (Rev, 3,'991 Previous editior <br />This is a 4-part form. PAGE of <br />