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PERMITTEE NAME/ADDRESS ilnrhtde Farilitt .4'antdLarurion i/Differrn!! NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS r. .', ! i' <br />EtOX PERMIT NUMBER DISCHARGE NUMBER <br />_''EtU MONITORING PERIOD <br />FACILITY ''~~ F1IiV~ 1, t. <br />YEAR MO DAY YEAR MO DAY <br />LOCATION -_"=N FROM TO <br />,. u non ar.r•• <br />N! I Nl7R <br />SUER .!C ! <br />F - F' I NAL <br />CFfRf7i'~IIG W>=T 1~57IN6 <br />Form Approved. <br />OMB No. 2(~0-0004 ~ <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ, FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT .- ~ ~ ~`'~ <br /> PERMIT <br /> REQUIREMENT <br /> <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 />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I rer[in under pa•twll) td law that thi. doanmrnt and all attachments wen' TELEPHONE DATE <br />pmparad under mp direction nr culn•nisinn in an•urdanor With a .ystem designed <br />~, <br />1n;4\Url' Ihal t{UYllfled pt•r+nnnel pf.rprrl~ gulher and Caalllate IhP Inrnrtllall..n <br />• <br />suhmiltrd. Navd un m} inyuin of the pennn nr percnnc oho manage the system. ~ <br />~~ <br />--' • <br />or th.nr I.rnum dirrdl. nrpnncihlr for guthrrinF tha• information, the information <br />1 <br />• <br />k 1 <br />i <br />cuhmitted is, to Ute beet ..! m. Anowledgr and helirf. tnn•, accurate. um <br />a <br />ump <br />te $IGNA RE OF PRINCIPAL EXECUTIVE ~ <br /> I am aware that thrrc are significant penuhiar lor.ubwitune /alcc information. <br />R <br />A <br />i <br />ti <br />i <br />l OFF ER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MQ <br />DAY <br />TYPED OR PRINTED u <br />.mc. <br />including lhr pKCihilit. of fine and impncunma•m <br />•r <br />n•~w <br />ng . <br />a <br />GVMMtrvIJ Arvv ~nrLnnr~IlVn Vr AIVT YIVLMIIVtYJ IrIC/C/CI14C mt aua~nntcnw nc.c/ <br />EPA Form 3320-~ (Rev. 399) Previous editioru may be used. _'4C~ Thin is a ~-P;•tt't fotTn. <br />