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PERMITTEE NAMElADDRESS rlnclud~ h'tuJin dame/lacarion if Ihffrrrnfl <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION ; r~„ C <br />Rr~ P. DVNF'EE. UIRECI"UR <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-ppOd <br />~~: <br />~ ,. <br />NOTE: Read Instructions t~efore 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 /> <br />I 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 />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER ~ ~ ~~•~ut. unJer Ix•nulq o(law Ihat Ihiad~KUmem amt all attachtnenL+were <br />un•d under m~ dirn~tion nr w <br />en-iaino in accnrduncr with ~ ~ <br />re <br />qem dr.ign<d TELEPHONE DATE <br /> p <br />p <br />p <br />~ <br />In a..ur< Ihut qualified p<r+nnnel prop<rh Rnlher and e. aluat< the inG~rntaGon <br /> mbmiurd. t{u+rd ~w my inyuin of the perarm ur In•rc~m. whu manaRr the •~.Irm. <br />~ <br /> m• Ihuv pen.m~ dirrcU. rnpunsible for I;atltering Ihr information. th< in(ormigon t <br /> .ubmitt<d r. to Ihr heel ~d m. knnrl<dRr and belief. True, wturate, and cumpl<te. <br />~ t <br /> I am aware that (here are.iRniflcunt <br />tnalun fur whmillin <br />fuly in(nrnwtino SIGNATURE OF PRINCIPAL EXECUTIVE - 1 <br />" <br /> <br />TYPED OR PRINTED ~ <br />. <br />p <br />indudding Ihr M.ibiliq of fine uttd im rn~mmem Grr know in <br />P~ p R ritJminns. <br />05FICER OR AUTHORIZED AGENT AREA NUMBER <br />CODE YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference atl attachments here) <br />EPA Form 3320.1 (Rev. 3~1 Previous editions may be used. Tlltti IS il -3-~1~1•t 10rtT1. PAGE OF <br />