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PERMITTEE NAME/ADDRESS flnclude FaciGrr ,Yaw+dLatarion if Differrnq <br />NAME <br />ADDRESS <br />FACILITY <br />LocarloN <br />c az~~ <br />+lA+a~R <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR M DAY <br />FROM TO <br />Form Approved. <br />oMa No zoaaoooa <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ, FRE OF NCY SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~_Y1=,„~ ,~ ~ ~ _ <br /> REQUIREMENT ''i ~ ~` <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT `~ ' <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ . - <br /> REOUIREMENT <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 rrrtif~ undrr pcnalh t,! law Ihul Ihi+dacumrnl and all alluchmrnh arrc <br />d <br />i <br />+ <br />ilh <br />J <br />di <br />i <br />i <br />i <br />d <br />t <br />d <br />i <br />d TELEPHONE DATE <br /> on ur mprn <br />n wrnr <br />anrr <br />s <br />es <br />prrpare <br />um <br />rr mr <br />rrct <br />s <br />on <br />a sy <br />em <br />gtr <br /> In a.+urr that yuulifiarl prnonnrl properly gather and r+uluale the infur'mati~m <br />- - suhmiltal. Bascd on uq inyuin of lbr perwm ur perxan- ehu manage for system. <br /> or Ihasc prnon. dim tly respmsihle fur gathrrirtg Ihr inforniatinn, the informnlMal <br /> w tlm hM of m+ wnuMied <br />submitted is <br />e and helirf <br />True <br />accurate <br />and aan <br />lrte • <br /> , <br />g <br />. <br />, <br />p <br />. <br />. <br />Ih <br />l th <br />i <br />t <br />lti <br />itti <br />i <br />ir <br />f <br />b <br />f <br />l <br />i <br />r <br />tl SIGNATURE OP PRINCIPAL EXECUTIVE - <br /> am awrrr <br />ere are + <br />ican <br />pena <br />ur su <br />m <br />ng <br />urma <br />on. <br />a <br />gn <br />es <br />a <br />se <br />n <br />OFFICER OR AUTHORIZED AGENT AREA <br />TYPED OR PRINTED including thr gnsitdlih of fine and Imprisonment fir km+wing sMiallom. CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />EPA Form 332x1 (Rev. 3J99) Previous elidions may t>e used. '=.j 1 ~ This is a 4-part ('(1riTl. <br />