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PERMITTEE NAMEiADDRESS tinclude Faciilry Niame2rcarian ijUijlerenr) <br />NAME <br />_ I <br />ADDRESS .Rt <br />FACILITY <br />LOCATION <br />1,0 8164' <br />1ANAGER <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 />I-- <br />LOT STORAGE TO PE1 <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />I_ L MEASUREMENT <br /> PERMIT t. REI'C:;" <br />F <br />i?L >•- REQUIREMENT I L_'/ Mx <br />_ . ` SAMPLE <br />r L i MEASUREMENT <br />! PERMIT r ?.._ :. DRI PE <br />" 'd ` ter; O:= i VALI. REQUIREMENT <br /> SAMPLE = <br /> MEASUREMENT <br /> PERMIT ( _ I i RL <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 ccruh under penult} of law that this document and au attachments were <br />d <br />d <br />di <br />t <br />d <br />d <br />m <br />h <br />d TELEPHONE DATE <br /> Prewe <br />un <br />er my <br />rec <br />ion or supentston <br />accor <br />ance wu <br />a system <br />esigne <br /> <br />S? ?? ?G?Q <br />i <br />e J f to assure that qunlilied pcm anal propel) gather and e,aluatc the information --'• _ ,. =_? <br />.a <br />. submitted. Based on my inquiry of the peon or persons who manage the system, <br /> or those persons directly responsible for gathering the informmion, the information - <br /> submitted m to the best of m knowiedge and belief. true, accurate. and complete <br /> <br />I em <br />it that th <br />re are si <br />nificant <br />enalties for submittin <br />false information <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED OR PRINTED awa <br />e <br />g <br />p <br />g <br />. <br />ossibilit <br />of fine and im <br />risotuncnt for knowin <br />siolations <br />includin <br />the OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MC, <br />DAY <br /> e <br />p <br />y <br />p <br />g <br />, COpE <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. -300 54 Thi g t3A 4-parL• form.