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PERMITTEE NAMEIADDRESS ri• <br />NAME <br />ADDRESS <br />~gCiLITY <br />LOrgTION <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMA) <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 /> NO. tntuucn~t SAMPLE <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION EX OF ~ TYPE <br />ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> <br />SAMPLE <br />`"' ~f <br /> MEASUREMENT <br /> ~- r ~'y i :: ~, I . IJ <br /> . .. c ~ # <br /> PERMIT Y# ~? -r _ <br /># <br /> M I n~ I i~tU;~' •" "~' <br /> REQUIREMENT <br /> SAMPLE - - ~ <br /> MEASUREMENT <br /> ' / ' '. Ii <br /> -t ,f#?i ~ #-: ~•it st ~ ~ r -tr31 •ri••s4•## ; ~ . <br /> PERMIT ~QD.A ,=•Vi:• :iAII_ti "I~~ MO;VTEf <br /> REQUIREMENT <br /> SAMPLE ... _ - <br /> MEASUREMENT <br /> ~ <br />'•~ <br />~ om I ~ <br />r <br />. ~Fi ~.: <br /> 'F '~'~.c 7•:t - ~ 1i ~,1 :Y '.f '~'~~•#'.t ',' <br />t'. <br />.~ t <br />. ~ _. <br />. <br /> PERMIT ` .j V C ;'; It <br />~ i1 t: MONTH <br /> REQUIREMENT _ <br />r:' <br /> SAMPLE f i <br /> MEASUREMENT <br /> _ <br />r <br />~ O <br />.•,,,• _ <br /> - f•3-=.## 'r_, : ,..< •, ##•I:~t#a j <br />~, . <br /> PERMIT 3C?'JF, = V~ ' •. <br /> REQUIREMENT - <br /> <br />SAMPLE - z .- - <br /> MEASUREMENT( ' <br /> <br /> <br /> PERMIT <br />~ <br />"t <br />{ <br />M. ~;.; i.r <br /> )Ci~i V:: . <br />i~~ 1l... <br /> REQUIREMENT <br /> SAMPLE 4 #' ..., ,• <br /> MEASUREMENT <br /> <br /> <br /> PERMIT <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br />• . , <br />. . <br /> IsOI-, -I R : - :F-z; -.: _, ~ . <br /> PERMIT <br /> REQUIREMENT A ~ . ' ~ ~ ~' ' <br /> TELEPHONE DATE <br />TITLE PRINCIPAL EXECUTIVE OFFICER <br />ME ! • ~'~t~t5 under r-~.41ry of lu~~ ibat un, d•~cwnent and ui! artaat.^teno ••+ere ' ~' ~ <br />NA <br />r r.•pur.,l under n!' dirci non .,r eupctv,.wn m ac.ord:m. e wah a +..tcm deitgual ~. ~ <br /> p <br />«> sewer thw qu..i~,Hcd per.onncl pr,p~•rl+ gutha :u,d c~aluaic the mli•mtauon _, ~~..~, ~. c ~' <br />~ ~ <br />_ .nhmit .d B, ~! 'P t,ty mywn- f 1 , I+tt. n .rc Ix•r••„n. •.~ho manage the .ys~tern• <br />mdrrmuuun <br />f <br />un <br />m <br />th <br />h <br />h l <br />_, _ <br />~' ~ - <br />' t ~ <br /> <br />t <br />._ om <br />, <br />e <br />c ,n <br />n <br />enng ! <br />.•r thu ~ rr r rt~ ~ufectlt m,p rsth! t t _at ~ <br />.. - <br />_ .~hn u i is t , Q r.best „( m•. kmr.~l~dci m I b-hcE w,t. auunt and .ompkr SIGNATURE OF PRINCIPAL EXECUTIVE <br />r <br />~ ~ <br />- ~ . ,;n il,u t' ie urr v¢nrtiwnr penullt I ~r suh: n,mne ul, ink,rmannn' OFFICER OR AUTHORIZED AGENT AREA NUMBER YEAR MO DAY <br />rvorn r1G DRMTFrI ! r do t: the r^ ~bi{it~ nt finc .,m: m.pr.Tmmcut t.n ~ t:~•«m< ti•dutium CODE <br />(COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />EPA Form 3320-1 (Rev 3,+99i Previous eC~' , -~~ :. - <br />I <br />