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PERMITTEE NAME/ADDRESS rlnrhtdr P'acil;ty 1a+,cl.,,, ,,n,", ;i lnpe r~ rug <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />.:~` :i3~~i~S <br />:~ ~r=L~ <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES) <br />DISCHARGE MONITORING REPORT (D A) <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 />1• <br />('f (~i <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY SAMPLE <br /> <br />EX OF <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 />_ <br /> PERMIT - J <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 />NAMElfiTLE PRINCIPAL EXECUTIVE OFFICER 1 crrlif~ umkr penalh of law that thi+dacumem and all attachments were <br />prepared under my dirn~uon nr su <br />rrvisi~m in ,KCUrdnncr with a s <br />:+tem dr+i <br />tnrd TELEPHONE DATE <br /> p <br />~ <br />> <br />to as+urr that yualifitd prrumnel prnprrh {+alher and rvnluatr the infonnadun <br /> wbminrd. Band un m~ inyuiry of the prr+rm or prrWm+ who manage the +ystem, <br /> or tb„+s• prts+ms dincih re+ponsible fur ~atheritgt the in/urmuti.m, the information <br /> +uhminrd r, to lhr br+t of mr km,wlydge and belief. lrur, ncrurute, rend rnmpkle. -' <br /> I am aware that there are siynifaant <br />rnaltie+Grr+ubmittinq frl+c infnrmatifw SIGNATURE OF PRINCIPAL EXECUTIVE - <br />TYPED OR PRINTED p <br />. <br />iraludin>; the pre+ibility of fiM• and impri mmrnt G,r Lm,winK siolation+. OFFICER OR AUTHORIZED AGENT AOREDA NUMBER YEAR MO DAY <br />AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. ~?B`_ This is a 4-part f'orrn. <br />