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<br />NATIONAL POW.UTANT DISCHARGE ELIMINATION SYSTEM (fiIPA+E$)
<br />DISCHARGE MONITORING REPORT (DMR)
<br />.PERMIT NUMBER DISCHARGE NUMBER
<br />~. ~.,=°~~• MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
<br />i _ =~ FROM .:-::~ _ ~. ~~ :. TO ~~3.R ~.~ '_ v ,
<br />Form Approved.
<br />OMB No. 2040-0004
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<br />NOTE:•Read Instructions before completing this form.
<br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY
<br />OF Spspgp~
<br /> EX TYPE
<br /> ANALYSIS
<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS
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<br />NAME/TITLE PRINCIPAL EXECUTNE OFFlCER I certify tmdcr prnalry of taw that mis docmnrot and ail atttchmcnts were TELEPHON E DATE
<br /> prepared under my direction or supervision in arxordanec with a system designed
<br />~7~.rPµ~ t 'rO~~ to aesurc that qualified persofficl properly gather and evaluate the mfotmation
<br />` •e+~ V submitted. Based on my inquiry otthe person or persons who manage the system.
<br />L ~ ~ ~ or those persons dsectly responsible for gathering the information, rite information
<br />submitted is• to the beak of my Imowlcdgc and belief, true, accurate, and complete.
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<br />SIGNATURE OF PRINCIPAt EXECUTING Q ~~~
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<br />I am aware that there arc signrfieant penalticc for submitting false informat OFFICER OR AUTHORIZED AGENT AREA
<br />NUMBER
<br />YEAR
<br />MO
<br />DAY
<br />TYPED OR PRINTED including the possibility of fmc and imprisonment for Imo~ing violations. CODE
<br />COMMENTS AND EJJCPLANATION OF ANY VIOLAT10N5 (Reference aA attachmeAfs Here)
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<br />EPA Form 3320-7 (Rev. 3199) Previous editions may be used. ,.,,~..~,., , „-, i~C ~Sr39..IpapE,~q~, PAGE ~ OF '~
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