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PERMITTEE NAME/ADDRESS *cludr Fac17ity.tiamf oc ion if thfferent) <br />NAME <br />ADDRESS <br />FACILITY I <br />LOCATION <br />GCS 514Gt <br />CF PRES. <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <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 />M1NL <br />(Sur. <br />F <br />Mi.1 1 <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREOUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <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 - i :' .. . <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAMEJTITLE PRINCIPAL EXECUTIVE OFFICER I certify under penalty or law that this document and all altachmentc were <br /> <br />d <br />i <br />h <br />d <br />d <br />TELEPHONE <br />DATE <br /> ance w <br />prepared under nit direction nr %upemkinn in accor <br />a %y%lem <br />esigne <br />t <br /> to allure that qualified perumnel properly gather and evaluate the information <br /> wbmiurd. Rased on my inyuin of the person or peramt who manage IM• sy.tem. <br /> or those pemins directly re pnnsible roe gathering the information. the information <br /> eubmilted is. to the last or nn knowledge and belief, true, wcurale, and complete. SIGNATURE OF PRINCIPAL EXECUTIVE - <br /> I am aware that then am significant penalties for whmitting falw information. <br />owi <br />%kdatiot <br />i <br />l <br />th <br />ibilit <br />f fi <br />d i <br />i <br />t fo <br />k <br />di <br />OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br />TYPED OR PRINTED u <br />e f- <br />y o <br />ne an <br />mpr <br />sonmen <br />n <br />ng <br />m <br />nc <br />ng <br />r CODE <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />EPA Form 3320.1 (Rev. 3199) Previous editions may be used. moils is a 4-Pali form.