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PERMITTEE NAMEJADDRESS ilnclrwk FacifBv Nama'Loration zf 1)ijjenqu/ NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPOES) <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS <br />PERMIT NUMBER DISCHARGE NUMBER <br />FACILITY MONITORING PERIOD <br />LOCATION : YEAR MID DAY YEAR MO DAY <br />FROM TO <br />Form Approved. <br />OMB NO. 2044-0004 <br />i< <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 /> MEASUREMENT <br /> PERMIT v 1 '1AF h!- 'Y Reif; <br />- REQUIREMENT MA k <br /> SAMPLE <br />- MEASUREMENT <br /> PERMIT a : ;• ., :,• vl ":F1AB <br /> REQUIREMENT <br />71 SAMPLE <br /> MEASUREMENT <br /> PERMIT r # <br />F rLtJ1 N! ?; _• ,_ _. REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ;> . <br />:. t. REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT r !71 NITIP4 'f•' <br />Fr- '. ` REQUIREMENT G'` f+l T <br />' SAMPLE <br />t KL! MEASUREMENT <br /> PERMIT t:• r. ?# EsF# rr. ,. _ :T NJ <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ;I, -, sta.. r-r R1 E r)r-, r t i! _ ?PA3 <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certify under penalty of law that this document and all attachments owe TELEPHONE DATE <br /> Prepared under my direction or supenision in accordance with a system designed <br /> to assure that qualified personnel property gather and csaluatc the mformrarmn <br /> submitted. Based on my nnquity of the person or persons who manage the system. ?? - <br />? <br /> or those persons dirtttl% rcsponsible for gathering the information. the information ? <br />- <br />?I and complete <br />submitted is <br />to the best of m <br />knowledge and belief <br />true <br />accurate <br />. . <br />. <br />. <br />. <br />y <br />. <br />t <br />to <br />no <br />h <br />t th <br />f <br />l <br />tt <br />f <br />l <br />i <br />f <br />b <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED' OR PRINTED ere are signi <br />ican <br />u: :n arc t <br />a <br />pena <br />ties <br />or su <br />mi <br />ing <br />a <br />se <br />n <br />ma <br />n. <br />r,.,! ,]:rr the <br />x+.snbnht <br />of find and im <br />risonment for knowing violations OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br /> f <br />p <br />. <br />y CODE <br />GUMMr-N D A N NW nAI'L.MYAI IMM yr hrv1 tll%J.rtrivtVQ II'101WFCIMM ail aaraW8111C11 ca 110+01 <br />IP PP _C TP P'-1F'I\1T - 5FE T P I C 3 FOP RF^'.!TRTMPPITg. <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. Thij jS,a 4-part form. PAGE OF