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PERMITTEE NAME/ADDRESS linclude Fmrild.s\mnril--arion d Different <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />?E LE-4-CH, 5R L-NV ENGH-4EE <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 />C HR ©I,4 I ( <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. <br /> <br />EX FREQUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ,. r : .. t- I , ,I.; V, - <br /> REQUIREMENT allgN J„ _ <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 />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I -airy under prmdti orw.o, that thi%document and all attvchment+rerc <br />prepurrd under m) direction or ,upeni,i,m in accordance with a -lem designed d' TELEPHONE DATE <br />- _, _`??+) , \,C?}-r , , ,?\ ? <br />' to a++ure that qualiRed prrwnncl pruprrft Gather and eraluatr the inf,xmatian i- <br />- .• • `_ +ubmitted. HaMd on nit inquir) or the peram or prmrn who manage the %y%tem, <br />? <br /> or th- perKrw dime th re,p,m,ihk ror gathering the information, the information -'- <br /> +ubmitted k, to the he,t of m) knotooWgr and brlier. true. s crurate, and compkte. - t ( <? <br /> I am aware that there am,ignirwant penaltie, for,uhmitting rake inrorntation SIGNATURE OF PRINCIPAL EXECUTIVE <br />TYPED OR PRINTED . <br />inchAing the rw-ihilih or nne and impriwnmrnl ror k,Iowing+iolation+, OFFICER OR AUTHORIZED AGENT <br />EA NUMBER <br />ARODE <br />C <br />YEAR <br />MO <br />DAY <br />GVMMtN I J ANU tArt_MI1M I Iwil yr MI7 r nvvM I Ivrto (nrrCrCrrt; an auacrrrnrrrts rrrrr/ <br />EPA Form 3320-1 (Rev. 3,199) Previous eddons may be used. ''- `'nIs Is:14-part form.