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PERMITTEE NAME/ADDRESS ~larlrut: !a<rhrr t,un:,l••„u,~~n ii tnlJ:r:m <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES) <br />DISCHARGE MONITORING REPORT (OMR) <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 SAMPLE <br /> <br />EX DF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ ., _ r.. .. <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 />~ <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 Inrtif~ underprnnll~ aflaw thatthiad,.nmrntand;dluuarhmem+wrrr <br />drr <br />o <br />~i+iu <br />rcco <br />e with a +.+tr <br />r <br />d <br />di <br />-lio <br />+ <br />x <br />i <br />da <br />dcsi <br />l TELEPHONE DATE <br /> p <br />epara <br />un <br />nn <br />tYV <br />n <br />r <br />ul <br />n <br />n <br />n <br />r <br />nc <br />m <br />Gnn <br /> io a+atrr that ytwli(rtl prtvmnrl prnprrl~ gathrr and rcalnale the information <br /> wbmitled. Ha.+YV1 un m~ inyuin of thr prrwm nr prram+ who manay,< Ihr +p+lem. <br /> nr those prr.ons directly- re+pnrt ihle for yathrrin~ the information, thr information <br /> whmittrd i>, to thr ttr+t of my Anowh•dgr amt Ix•lirf. trw•. accura4•, and rompls•tr. <br />e that thr <br />r <br />b <br />fo <br />I <br />w <br />e +i <br />ifk <br />m <br />e <br />alties G <br />s <br />itti <br />faki <br />i <br />tio SIGNATURE OF PRINCIPAL EXECUTIVE <br /> am a <br />ar <br />r <br />ar <br />><n <br />v <br />p <br />n <br />,r <br />u <br />m <br />ntt <br />r <br />n <br />rma <br />n, <br />OFFICER OR AUTHORIZED AGENT AREA <br />TYPED OR PRINTED imiudiny the possihiliq of fine and imprisonment for Isnawint; sudatirao. CODE NUMBER YEAR MQ DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference atl attachments here) <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. Th1s IS a 4-p3R COl•Itl. PAGE OF <br />