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PERMITTEE NAME/ADDRESS Ilncladr F'arilitr :\'antdlnrotinn if DifjrnM~ NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />NAME <br />ADDRESS <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />FACILITY <br />YEAR MO DAY YEAR MO DAY <br />LOCATION FROM TO <br />Form APProved. <br />OMB No. 2040-ppp4 <br /> <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY <br />of SAMPLE <br /> <br />EX <br />ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT - <br /> REQUIREMENT . <br /> SAMPLE -- <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT i <br /> SAMPLE " <br /> MEASUREMENT _- __ -__- <br /> <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT • <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br />ME/TITLE PRINCIPAL EXECUTIVE OFFICER I ca'rtd~ under prnalq of law that thi> dfKUORnI and all attachnrrnts wcm TELEPHONE DATE <br />NA prepared under my dlrrrtion wr wpenision in acnxdnncr with u »+trm desiEned <br /> to msurr that yualiRed personnel prnprrl~ gather and e+alunlr the intotmaU~m <br /> cubmittrd. R~>ed on mr inyuir} u( the person ar prrw>ns wbo manage Ihr y+iem. <br /> xisiMr (or gatbrrintl the in(nrmatHm. Ute intorm+liun <br />wns ditritil <br />rr. <br />o <br />th <br /> ~ <br />g <br />r <br />u+r per <br />whmiurd i>. bi the he>t of m~ knowicdge and belief, true, aaiurate, and cwmpkle. SIGNATURE OF PRINCIPAL EXECUTIVE <br /> 1 am aware that there are >iknifk~m prnultic+ fur wbmitting tal+r intormad~n. OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br />TYPED OR PRINTED including lbe p~»ibilih of vine and imprionmrni for knowing+inlatioos. D <br />COMMENTS AND EXPLANATION OF ANY vIULA I was Irreverence an auacnrnrnta nrra! <br />~~ :44i r •L'v:~:US GL'iLOnE 'nsq C- __ I lii~. I• .. - ~ ~~-'. i~tI III. <br />EPA Form '32G-t iRev _ <br />