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PERMITTEE NAME/ADDRESS (include Farilityovamrgncaden i(niffrrrN) <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />E, f'AN-6Jr+, 'VICE 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 />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION N0. FREOUENCY 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 <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 /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER I certify under prtmlo of law that this document and all attarhmenl%were <br />prepared under my direction or supervision in accordance with a ststem designed <br />TELEPHONE <br />DATE <br /> to assure that qualified prrwmnel prwperiv gather and esaluale the information <br /> submitted. Based on my inquire of the perstm or persons who manage the "tem. <br /> or those larrseas direvily responsible for gathering the information. the information <br /> submitted u, to the best of my knowledge and belief, true, accurate, and complete. i " <br />' <br /> I am aware that there are significant penalties For submitting (also infornali„o. SIGNATURE OF PRINCIPAL EXECUTIVE - - ? <br />?- <br />TYPED OR PRINTED imluding the Possibility of nine and imprisonment for knwsving vi,dations. OFFICER OR AUTHORIZED AGENT A <br /> <br />REA NUMBER <br />CODE <br /> <br />YEAR <br /> <br />MO <br /> <br />DAY <br />tAYLANAIIUN Ul- ANY <br />(HererenCe all arracnments here) <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. Thiti is t3 4-part form.