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PERMITTEE NAMElADDRESS Uncladr F'arility .4'anlr/1.IraNon if Ui/jrnntl <br />NAME <br />ADDRESS _ _ <br />N~ <br />Faclt_m .3 ~ <br />LOCATION N A <br />g <br />+.:1J E3142 <br />E PRES. <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES) <br />DISCHARGE MONITORING REPORT (D R) <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 />1 1 i 1~4Jf1 <br />(~UF3R MH i <br />F' - F I f`IAL <br />tr9INE DRAItk AGE TO CUNNI~ <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ, FREQUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> EX ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> IiEQUIREMEN7 <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 />NAMEffRLE PRINCIPAL EXECUTIVE OFFICER I aeniry under prnalt~ of Inw that thi+dakumrat and all wwchment.were <br />u <br />ed u <br />de <br />di <br />~tlo <br />o <br />•ni <br />with <br />i <br />i <br />d <br />N <br />d <br />i <br />d TELEPHONE DATE <br /> prcp <br />r <br />n <br />r m~ <br />n <br />r wpa <br />.m <br />o accor <br />a +) <br />m <br />+ <br />ance <br />em <br />r+ <br />klw <br /> to a<+ure that qualified personnel prnperlr gathrr and r. aluata• lla• infnrmatial <br /> •ubmittrd. Rxxd un m. illyuin of the prrwn or prrval+ wMl nulnaKr thr +r+4m. <br /> nr tMne per+am+dim~tl+ rr+gln+ilde for lwthrring the information. 1M• infwmatinn '' <br /> whmitlad i , to thr best of m~ knowledge and helkf. True, nccurote. and complrte. <br />I am aware dull thrre arc +iytnifia•ant ptmalties fur submitting falx infunnation SIGNATURE OF PRINCIPAL EXECUTIVE ' <br /> <br />TYPED OR PRINTED . <br />indlaiing the passiMliy of fine and imprislmmrnt far knuwin* siolatiun+, <br />OFFICER OR AUTHORIZED AGENT <br />AREA NUMBER <br />YEAR <br />MO <br />DAY <br />NI~V CArLr119NIIV I• Vr MIDI YIVLNIIVI\J IrlCIC1 CI/VC 2r1/ Clttlf:/IIfIC11t.`i IIC/C~ <br />EPA Form 3320-1 (Rev. 3/99} previous editions may be used. _ .. "Tltlti iS 8 4-dart EOTm. <br />