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PERMITTEE NAMEIADDRESS (include Facility A"amr1location if lhfferevni <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br /> <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 />(51. <br />F <br />r E;? <br />?i <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY 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 I <br />N <br />A <br />`? <br />`? <br /> MEASUREMENT ! nt t? <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 />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER ? vrtil> tinder rx-nuiq or to% that thi, dtrument and all allachmenrs were <br />ated und <br />cYk <br />or <br />i%io <br />cco <br />r m <br />di <br />i <br />da <br />c <br />with a <br />d <br />d <br />i <br />d <br />•' TELEPHONE DATE <br /> <br />L 1 11I .'? _ pup <br />e <br />y <br />n <br />m <br />wlMn <br />n <br />n a <br />r <br />n <br />e <br />y <br />em <br />gne <br />es <br />In assure that qualirtrd prminnel proper1% gather and etaiuate the information i / <br />_ ,? <br />- -- <br />• _ ` <br />r-" <br />submitted. Ha+ed .m my inquiry or the 1-n or prrwm% who manage the saltm, r <br /> or thine pemons directi? mslannil k- fot gathering the mrarmutiun, the information ' - - - <br />.t -- %ubmirted h, to the hN of m% knowledge and belief, trve, arrurate, and complete. <br />? <br />_ 1 am aware that there are dgnificam penuitie% for submitting fide inrurmunon SIGNATURE OF PRINCIPAL EXECUTIVE " - • '? <br />TYPED OR PRINTED , <br />including the lansihilits tdrine acid impriwmment rar knowing %Wations. OFFICER OR AUTHORIZED AGENT CODA NUMBER YEAR MD DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Re/erence all attachments here) <br /> <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used -0284 This is a 4-part fonn.