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PERMITTEE NAME/ADDRESS ilnrladr Farilirr Namdlnratinn iJUtJJtrtul <br />NAME - .;~_:_ •:i-;i1~J1 LLG <br />ADDRESS - ' ' C, ~ ~)` <br />•, bcc3 <br />GO 814 <br />FACILITY _'.;{ i ,~; 1~y pj j (.iF <br />LOCATION ~ ~ 1 q~ <br />~AIVi:E WADE, t`t a IvE MA9+I~C fR <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 />D'}i~J.1 R <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION <br />NO. FREQUENCY <br />SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE ~ - • <br /> MEASUREMENT <br /> PERMIT - ~ -- - . •, .. -r . ,. ~ ~ ,~, . t.. ,.... <br /> REQUIREMENT <br />..., :. <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 />NAMElfITLE PRINCIPAL EXECUTIVE OFFICER I ccrtira under penau~ ar law wet wis ducanamt and all aiu.ahmnnt. were <br />re <br />ared under ma directiinn or et <br />eniai~m In aacurdance with a a <br />stem desi <br />lwd <br />-" TELEPHONE DATE <br /> p <br />p <br />p <br />) <br />g _ _ <br />~ ` <br /> to assure wet yuulifieA prr+.mtxi pruprrir gather and c. aluate Ibr information <br /> aubmhled. Bused un ms inyuin of the perxm or yersuns who marmge the ssaten4 <br />L I •~ <br />~ <br />` <br />-- - - or lhme prrs~at> dirce <br />y respoa5ibk for gathering tha• information. the In(ormatton <br />- <br />' ~ ~ ~ suhmiltrd is. to lhr hcrt o(mr knnaledgie and belirl, trur. accurate. and rnmpletr. <br />I am aware that there are d <br />nificant <br />xnaltiea fur submittin <br />false inrormathw <br />SIGNATURE OF PRINCIPAL EXECUTIVE ~ !'~ iii <br />• ~ -' <br />- ~ <br />- <br />~ ~ ' <br /> g <br />t <br />g <br />, OFFICER OR AUTHORIZED AGENT AREA <br />TYPED OR PRINT including the pusalbllit~ or fine and Imprivmmrnt for knowing ai~duliuns <br />-- - - - . NUMBER <br />CODE _ YEAR <br />. MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />EPA Form 3320.1 (Rev. 3/99) Previous editions may lie used. ~ 1~~9~ Thin is a'4-dart-form. <br />