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PERMITTEE NAME/ADDRESS /include Faciliry,~mnc'T.ocarion ijpi,(jerenU <br />NAME .. ,, <br />ADDRESS - <br />FACILITY - <br />LOCATlON , • ; E~ E <br />t U t7 1 bK~ <br />.,.3E ~`'rA!`1F`rCER <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (IVPDE3) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />l <br />Form Approved. <br />M I NQR OMB No. 2040-0004 <br />t SUZ;Ft DW 3 <br />F - FINSAL F?~LAiti ~ <br />RF'-~~c3 SERI PL7ND TO RED WR:~F-; <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE ` ' <br />~,: 1 MEASUREMENT <br /> <br />PERMIT .- ~._ <br />*"F REQUIREMENT rte' ' ~ ' ~' <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 />NAME/T1TLE PRINCIPAL EXECUTIVE OFFICER I certify under penalty of lau that This document atxl all atuxhnten~ were <br />creuwn m accordance with o sy~acm designed <br />r <br />ar <br />d und <br />r my dtrcction or su TELEPHONE DATE <br /> p <br />ep <br />e <br />e <br />p ~ <br /> to uwre that yuaSitiui personnel pmprrly bethcr and evaluate the m(ormnriun ' <br />Sr r%%' /,_ ; submitted. F3asrd on my ittquiry of the person or prr~orts who manage the system. -r---"~% <br />,~ - --- <br />- <br /> or thou psnons dtrectly responsible for gathering the information. the information - ` <br />-~ submitted is, to the hest of my knowledge and bcGrf true. xccuntr. and wmplcte <br />b <br />i <br />L <br />l <br />f SIGNATURE OF PRINCIPAL EXECUTIVE ~ /~ <br /> ormation. <br />I am ow ore that there arc signilicnnt penalties (or w <br />mitt <br />ng <br />r <br />u in <br />d i <br />i <br />k <br />l <br />f f <br />i <br />l OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br />TYPEp OR PRINTED mprisonment t <br />:r <br />n,~wtng v <br />ancros. <br />tncludmg the possibi <br />ity o <br />loc an <br />o CODE <br />COMMENTS AND EXPLANATION OF ANY vIOLATwNS (Hererence air artacnmenrs Here/ <br />--1~R RECIP. L-VI~N~ - 5EE <br />. ~ SAPti'L_TNG INSTRUCTION <br />A. 1~ P~. 3. FOR REQUIhEPgL-N <br />Z. C. 7. P6. 14. <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. '~O ~ 1 G '. ' T~14$ ~Sr2 4.131`(. lOTm. <br />