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PERMITTEE NAME ADDRESS <br />NAME <br />ADDRESS _A <br />FACILITY <br />LOCATION <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) Form Approved. <br />DISCHARGE MONITORING REPORT (DMR) OMB No. 2040-0004 <br />PERMIT NUMBER DISCHARGE NUMBER FINAL RD'-AN r <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREOUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br />- PERMIT <br /> REQUIREMENT t\i . ii; ?; i i il.: i•1 `'' `h? <br />-`' SAMPLE <br />`?F El is MEASUREMENT <br />- , PERMIT 3+ ,h t ii I: It- ?. T A9 <br /> REQUIREMENT it.i(c I <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT r3 f-i :' ,F rah <br />t r - REQUIREMENT <br />; F j SAMPLE r ; <br /> MEASUREMENT <br /> PERMIT >? : t; t : ?5,.?! i. t :. # :: CJNT' 2N °AI3 <br />rz _ . REQUIREMENT TENT <br /> SAMPLE <br />T r, < , y•T MEASUREMENT <br /> PERMIT ?- r 1to Ai <br />r- p . REQUIREMENT I II I l !' <br /> SAMPLE <br />nit - MEASUREMENT <br /> <br /> PERMIT ,. <br /> REQUIREMENT <br />NAMETITLE PRINCIPAL EXECUTIVE OFFICER I c-ify under penalty of law that this document and all attachments were TELEPHONE DATE <br /> prepared under my direction or supervision in accordance with a system designed <br />l • <br />? '" ' <br />' <br />{ <br />? to aSYUfe that qualified pef5nrlrifl pfopeTlV gflAler and evaluate the inCotmatntn <br />• <br />' L <br />° 1 <br />i • <br />•- submitted Based on my inquiry of the person or persists who manage the system, <br /> or those persons directly responsible for gathering the information, the information ` <br />' _ ?. <br /> knowl <br />tud belief <br />accurat <br />and com <br />lete <br />b <br />d is <br />t <br />th <br />b <br />t <br />f m <br />d <br />c <br />We <br />itt 6 - - •+- - <br />' <br />' G ?• ' <br /> . <br />su <br />, <br />o <br />a <br />o <br />y <br />e <br />b <br />s <br />, <br />e, <br />p <br />. <br />m <br />e <br />e <br />f <br />f SIGNATURE F PRINCIPAL EXECUTIVE _ <br />, <br />r t. ms <br />s. <br /> <br />TYPED OR PRINTED ommt:,.n, <br />alse m <br />!n am swore that there are ignificam penalties for submitting <br />ncluding the possibilip of fine and imprisonment for knowing t uolanc'ne OFFICER OR AUTHORIZED AGENT AREA <br />CODE NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS ANU tXYLANAiIVN tit ANT VIVLAIluNJ (nererence au dUdGnrnenr5 "ere) <br />{R PRE <br />IREM <br />EPA Form 3320-1 (Rev. 3/89) Previous editions may be used. TWs. IS a 4-part form.