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PERMITTEE NAME/ADDRESS rirtelwk Facility Ala. Locadon rJDifjertrnr) NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS .. J[) 0 I N <br />rl ;nt - . PERMIT NUMBER DISCHARGE NUMBER <br />J MONITORING PERIOD <br />FACILITY <br />LOCATION , YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved. <br />OMB No. 20404004 <br />`''$LAN <br />1? <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY <br />OF SAMPLE <br /> TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />j- MEASUREMENT <br /> PERMIT <br />:. F REQUIREMENT Mrirl <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 ccrtiN under pcmrdty of Ia- that this document and dll attachments were <br />d <br />-i <br />i <br />d <br />i <br />h <br />d <br />i <br />d <br />e TELEPHONE DATE <br /> irection or supen <br />ance w <br />a %yItern <br />prepar <br />d under my <br />s <br />on to accor <br />t <br />es <br />gne <br /> to assure that qualified personnel properly gather and esaluate the information <br /> submitted. Bated on my inquiry of the Person or persons who manage the s)-stcm• .- <br />g <br /> or those persons directly responsible for gadicnng the infomwtion. the information , <br />- <br />" - <br /> f <br />d i <br />h <br />t <br />k <br />i <br />d <br />d b <br />h <br />f: t <br />d <br />l <br />t <br />h / <br />_? . <br /> <br />' s, to t <br />cc <br />o <br />my <br />nou <br />e <br />ge an <br />t <br />e <br />rue, accurate, an <br />comp <br />e <br />e. <br />submitte <br />e <br />1 am <br />a <br />t th <br />Th <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />.- <br />TYPED OR PRINTED ware <br />r <br />a <br />r <br />• <br />4 <br />h <br />l <br />di OFFICER OR AUTHORIZED AGENT C <br />pE NUMBER YEAR MO DAY <br /> iT. , . <br />rg :hc p- <br />w' <br />,.r i , n .. • <br />.T n- <br />mc <br />u o <br />COMMENTS ANU EXPLANAIIUN Ur ANY VIULAIIUNS (Hererence an anacnmenrs nere) <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. 58 This is a part form.