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PERMITTEE NAME/ADDRESSllnrlude Farilitp:lamr%L.uati~.n if NiJf.nnn <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />LNGjNE~F2 <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />DISCHARGE MONITORING REPORT (OMR) <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 />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION <br />NO. FREQUENCY <br />QF <br />SAMPLE <br /> EX IS TYPE <br /> ANALYS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT ~'~ ~'~•~ N ~tS~ a~`v~- <br /> <br />PERMIT <br />~ - - <br />J tit. 4; ~_._.. <br /> REQUIREMENT '- ~,~, <br /> <br /> SAMPLE ' <br /> MEASUREMENT <br /> PERMIT f <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 />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER 1 rertifc under penults otl+,• that thi. document and all altnrlunrnl. wrm ~ - ~' TELEPHONE <br />~ <br />~"'`~ DATE <br />~--- <br />% f <br />prrlwrrd under m. Airecti•~o ~a~ wga•rri.ion in arrordum~c with a .~uem desigmd _ __ 4 <br />P <br />~ <br />` <br />~_~/ <br />_ , .... v ` : _ .-- yY`a ,,~ ,` C b. aacure that qualified pen• nnrl pngrcri) pylher rod raalu:rir tlu• informuliun <br />1 <br />wh <br />r the s.+te <br />~ ~ <br />f <br />m <br />ma <br />t <br />h <br />_. <br />e prrs.m or perw,na <br />a <br />yµ <br />m. <br />submitted. <br />tu.ed on m. imtun , .. <br />t <br />o <br />• <br />-. { ~ <br />' <br />or th,na• prnon. dtread. rr•Iwn•ibie for uutha•nnc the infornratiun, the in(ornralion <br />- <br /> <br />C <br />~ <br />C <br />} j(,. t~ V 1 ~ <br />lMe _- = <br />acrd rom <br />Hled <br />e rod brltef <br />true <br />:u-rurutr <br />itt <br />d n <br />t <br />th <br />! <br />r <br />An <br />t <br />b <br />1 .% <br />~ ~ . ~ <br />~: <br />. <br />, <br />p <br />\ _ <br />cu <br />m <br />, <br />v <br />rc <br />o <br />~ <br />. <br />_ <br />a <br />e <br />u <br />n„ <br />• -S"'~ SIGNATURE OF PRINCIPAL EXECUTIVE <br />` <br />_ <br />_ <br />\ I am uworc th:u Utrra• urr _~,colf~rant prnaltir. for >ubmnunk frJ,e information. AREA <br />TYPED OR PRINTED mdudinK the pos.ibiliry rd lino uml impri mment roc ktrnwln~ rirdutionc, OFFICER OR AUTHORIZED AGENT D NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VfOLATIUrvS (Reference an atracnments nere/ <br />r <br />~` ~ , <br />EPA Form 3320-1 (Rev. 3/99} Previous editions may be used. <br />TI»~ Is 3 ~-part fOfnl. PAGE OF <br />