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PERMITTEE NAME/ADDRESS!lnrit~dr Iacililc ~'ameloran~~n i/ItiJJnmt) <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />-~? ~] ~-: <br />'.AG1=F, <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 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 NQ, FREQUENCY <br />OF SAMPLE <br /> EX SIS TYPE <br /> ANALY <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT _ <br /> AEQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ' <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> AEQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT • <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> - ~i. <br /> PERMIT . <br /> REQUIREMENT Y rl <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT -.r - > - ~~ ~: <br /> REQUIREMENT ' <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ... ~ .-' ~• •- <br /> AEQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I rertiry nnder prnalq of mw that thi+ducninrnt and all xurKhmenty wrrr TELEPHONE DATE <br /> pn•pxrrd under nq direction or wprn loon in xccnrdance with a scstem darigneel <br /> to aswrr that gtulifiarl pertiunnrl pmperi~ anther xnd rynluatr thr information <br />- _ _ - ~abmittrd. Paved on rtts inquiry of the person nr prrsnn~ who manegr thr cp~trm, <br /> nr thn.e pcnonr directly responsible for gnthrring for informxtion. lhr Infnrmxtiort <br /> d <br />lN <br /> <br />~ cump <br />yubmittrd i+, to the hest of m~ Annw1edgr and hrlief, true. aarurxle. an <br />e. <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />TYPED OR PRINTED' I am aware that there ere siRniM-am penaitica for whmittinq falx informxtion- <br />including for ptscibilit~ o! fine and imprixutment for krxrwinq ~iolalions. OFFICER OR AUTHORIZED AGENT AREA NUMBER YEAR MQ DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />EPA Form 3320-I (Rev. 3/99) Previous editions may be used. This is a'4-part frnm. <br />