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PERMIITEE NAME/ADDRESS an,wr Fwaitr.N..w Location if ixfJerentl <br />NAME L <br />ADDRESS <br />'ter 3? <br />FACILITY <br />LOCATION <br />R <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, I MO DAY <br />FROM TO <br />Form Approved. <br />OMB No. 2040-0004 <br />iNTR5 <br />F I7R <br />NOTE: Read Instructions before comntetina this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION N0. FREQUENCY SAMPLE <br /> OF <br /> EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT r: u . •:, , <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT _ <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ":f s I-,r- r. <br /> REQUIREMENT N ANTI <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT _ ?. <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT :.. , . _ <br /> REQUIREMENT i)P, I' , •i <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT ?.I`;--i , <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certif., under penult) of Ina that thi+dlwumeni and all attachment-em <br />d <br />d <br />di <br />t TELEPHONE DATE <br /> Prepare <br />un <br />rr me <br />rec <br />ion or uper%iaon in accordance with a -lem deigned <br /> lo ac+urc that qualified per+onnd properi% gather and c%aluate the information <br />-- - -- --- -- <br />" %uhmilted. Haad on m% inquin of the pennon or prrwn. who manage the +y.+lrat. <br /> or tho persona direcU, re-np.-ibic for gathcring the information, the information - <br /> suhmilted ia• to the he+t d m> knowir4gr and belief. true, accurate, and complete. . _. <br />1 r <br /> 1 am aware that there arc aignificanl penaltie+ for whmittin <br />fake information SIGNATURE Of PRINCIPAL EXECUTIVE - <br />TYPED OR PRINTED it <br />, <br />including the "ibdtty or fine and imprivatment for knowing+kdatium+. OFFICER OR AUTHORIZED AGENT <br />I AREA NUMBER <br />CODE YEAR MO DAY <br />vvnne???+av e+??v liar ?r+??r•+??v?+ v? r+?+? ?,va?r+??v??v Irloler Grll.G OII Ol r04IIf IfurllJ lierful <br />EPA Form 3320-1 (Rev. 3M) Previous editions may be used. (10407