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PERMITTEE NAMEIADDRESS ilndwlr F'ariGh ~'amdloration ijfhffarntl <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <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. 2040.0004 <br />iWFs <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ, <br /> <br />EX FREQUENCY <br />OF SAMPLE <br /> <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 /> 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 />NAMElTITLE PRINCIPAL EXECUTIVE OFFICER 1 certir) antler prnau...t la.~ that thi+dxumrnt attd all altwhmmts weer <br />i <br />h <br />i <br />d TELEPHONE DATE <br /> preparaKl under nn dirntion or supenisioo in an ordancr w <br />t <br />a +yriem drs <br />>Zne <br /> In atiwre that qualified personnel pr~~pcri~ knther and e~aluatr the inforntation <br /> wbmiltrd. Nand ..n m) inyuin of the per.nn nr prnoaa wbo manage the .~•stem. <br /> or flare persons dirrclly responsible for gatberirtK the infurmatLm, the infurmn6nn <br /> <br />-" submitted i. a. the Brat of nn knowirdgr and belief. true, accurate, and complete. <br />f <br />i SIGNATURE OF PRINCIPAL EXECUTIVE <br />- <br />~ <br />TYPED OR PRINTED 1 am aware that Ihrrc are siKnifnvnt pmaltirs for submittitt>; <br />alse informat <br />uo. <br />ixludlnK the possibilitc of fine and imprisonmem for AnowinK.iulationw <br />OFFICER OR AUTHORIZED AGENT AREA <br />ODE NUMBER <br />YEAR <br />MQ <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />EPA Form 3320-I (Rev. 3;99) Previous editions may t>8 used. This is a 4-~:17t ti)inL PAGE OF <br />