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I <br />Form Approved. <br />PERMITTEE NAME/ADDRESS !Include Facility .Yamdlnratiun ijDi,Q'nenJl NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) OMB N0.2040-000'0 <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS <br />PERMIT NUMBER DISCHARGE NUMBER ~ <br />~<it /YAMPA <br />FACILITY MONITORING PERIOD <br />LOCATION YEAR MO DAY YEAR MO DAY ~r <br />FROM TO ~ ` <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 /> 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 />NAMElfITLE PRINCIPAL EXECUTIVE OFFICER I crrtif7 under penalty of law that this doavmrnt uttd all puarhmrnts were <br />de <br />di <br />lion or s <br />isin <br />~o <br />with a s <br />ed <br />e <br />i <br />d <br />n <br />sY <br />r da: i <br />d TELEPHONE DATE <br /> y <br />prepar <br />un <br />r my <br />m <br />up <br />n <br />n <br />n aa <br />r <br />at <br />e <br />rn <br />kna <br /> to ~ sure that qualified personnel prnperl7 gather and es aluutr the informaion <br /> suhmiltrd. rfavd on my inyuir. of the p•nun ur perv,ns why manage the gatem. ~= <br /> ar those prrs,ms dirrrtl~ rrsponsiMr for gathering the information, the information ~ <br /> svMnitted is, to the !n•.t ..f ms knowledge and lr~licf. true. accurate, and rwppkte. <br />I :uu aware that Ihor. ire .ignifo~nt p<nultl<r }ar whtnllllpg fare Infarnla/lup $IGNATUHE OF PRINCIPAL EXECUTIVE <br /> , <br />OFFICER OR AUTHORI2E0 AGENT ~ <br />AREA <br />TYPED OR PRINTED m.luding the pr,ssiLdu~ ~~t fine anA nnpris~uunrnt for knpwing ebla0un~ NUMBER <br />CODE YEAR MQ DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Re/erence all attachments here) <br />EPA Form 3320-1 (Rev. 3/99) Previous tWtions may be used. This i9 a 4-part form. PAGE OF <br />