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FERMITTEE NAME/ADDRESS pneYleF«~lryNwvtoe~rten 1lDlpt.enr)
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<br />NATIONAL POLLUTANT DISCHAAOE ELIMINATION SYSTEM //NPDESJ
<br />DISCHARGE MONITORING REPORT /DMRI
<br />PERMIT NUMBER DISCHARGE NUMBER
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<br />YEAR MO DAY YEAR MO DAY
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<br />Form Approved.
<br />OMB No. 2040-0004
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<br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO,
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<br />NAMElTITLE PRINCIPAL EXECUTIVE OFFICER l ~~'Ir u er pena 17 o Isw that U
<br />prepared under m~ direction or sup th doavment snd dl attachmenb were
<br />errlalon In aceordann wllh • a~slem dd`ned TELEPHONE DATE
<br /> to Hoare the quaHRed personnel properly ether and eraluale the Informallon
<br />anbmltted. Bated on my Inquiry of the person or persona who num6e the ayrtem,
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<br />iJYPED OR PRINTED Inclualnt the poslDllllr of Rne and Imprlaonmenl for knowln~ rldatio~ OFFICER OR AUTHORIZED AGENT CODE NUMEIER YEAR MO DAY
<br />COMMEN9T^S AND EXPLt(AtNATION OF ANY VIOLATIONSS (R~l~r~nc~es/l ~tt~chm~nts h~r~l f~ ~t~ y~ f', y+~ f-+~ p q;~ i. p~, ~t
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<br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. ~ ~, '~tus-IS a 4-.~art.f~OflTl.
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