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PERMITTEE NAME/ADDRESS flndade ParQity.YamrRurarinn iJlNjferrnri <br />NAME <br />ADDRESS <br />FAClurr <br />LOCATION ~.. ~7 ~ <br />•~\, VLGE PR <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 />~l <br />r <br />GHF <br />NOTE: Read Instructions before completing this form. <br /> <br />PARAMETER pUANTITY OR LOADING QUALITY OR CONCENTRATION NQ, FREQUENCY SAMPLE <br /> <br />EX OF <br />TYPE <br /> 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 ~ s = ~ : ,. - <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> <br />PERMIT . ~ ~ •. ~ . <br />.. <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ` t" <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ~ i , <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I rrrtif+ under {a•nult} of laa that thi+drK~umrnl anal all altaBtmcnls aere <br />prrparrd under nrr dirrdion or +upcnision in aacordancr with a s <br />~strm desi <br />ned TELEPHONE DATE <br /> f <br />g <br />to a Burr that qualified persnnne! prnperl~ gathrr a~ e+almte the iaformWMa <br /> whmiltcd. Naval nn m~~ inyuin of thr pawn or prnom aho tnan:tgr thr s~utm, <br /> or thu+e pervrau dirrrU~ mlam+iMc for Knthrring the information, tht information <br /> submitted i+, dr tM• be+t r$ my knna kdKc and helirf. trtx. uccuratr. and nanplrtr. <br />I am aaare that there urr +ignifkant <br />rnuNir+ for whmittin <br />information <br />fals <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />TYPED OR PRINTED p <br />e <br />. <br />K <br />in.9udinq thr prssihilih rdfinr and impri+anmem fur AnnainK rinlmionw OFFICER OR AUTHORIZED AGENT AREA NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />EPA Form 3320-1 (Rev. 3/99) Previous editror>s may be used. _ ~~12S7S 8 4-p8rt tOflll. <br />