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PERMITTEE NAME/ADDRESS pnclade Facility Name/Location if Different)
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<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NPDES)
<br />DISCHARGE MONITORING REPORT (DMR)
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<br />PERMIT NUMBER DISCHARGE NUMBER
<br />MONITORING PERIOD
<br />YEAR MO DAY YEAR MO DAY
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<br />Form Approved.
<br />OMB No. 2040-0004
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<br />NOTE: Read Instructions before completing this form.
<br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO•
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<br />TYPE
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<br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS
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<br />• REQUIREMENT:'
<br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certify under penalty of law that this document and all attachments were
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<br />SIGNATURE OF PRINCIPAL EXECUTIVE
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<br />COMMENTS AND EXPLANATION OF ANY vwLA I wNS fHererence au arracnmenrs nere~
<br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. ~~) ~ ~, ~. f ~T~'lf ~~s~'a~4=.pait~f~i~in• PAGE ~QF
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