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PERMIITEE NAME/ADDRESS r/nrJrde fa~ifil7,Vowd(,ayrun i/Dif/~r~nt! <br />NAME <br />ADDRESS <br />FACILITY ` '- <br />- r {- <br />LOCATION <br /> <br /> <br />PARAMETER <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 /> PERMtT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEl.1 r(NPDESJ ~~~"r, Appr:;vcd <br />DISCHARGE MONITORING REPORT (DMR) OMB No. 2040-0004 <br />_~jji~ <br />PERMIT NUMBER ascNARGe NuMSER - : <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />r ' FROM TO <br />NOTE: Read Instructions before completing this form. <br />QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br />EX ANALYSIS TYPE <br />AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ~ <br /> <br />I~#L. Y <br />EPA Form 332r~-1 ~F_.v 399, °revr;c~ edi6-;as r <br />r'ay b,; u~.~d <br /> <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />OFFICER OR AUTHORIZED AGENT AREA NUMBE <br />'This is a ~3-part form. <br />