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PERMITTEE NAME/ADDRESS flnclade Faciliq.Vatne/Location if UifJerent <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br /> <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 />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 /> <br />M <br />R <br />AS <br />T <br />?l <br /> <br />f1 <br />c <br /> E <br />U <br />EMEN <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />S <br />M <br />/ , <br />`=k <br /> MEA <br />URE <br />ENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />MEAS <br />R <br />M r <br /> U <br />E <br />ENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />M <br />AS <br />R <br /> E <br />U <br />EMENT <br /> PERMIT „ <br /> REQUIREMENT <br /> SAMPLE <br />MEASUREMENT <br />VQA <br /> PERMIT t' ?? .. t i •r i . s <br /> REQUIREMENT _ I t y.. ?Ir 11,: i <br /> SAMPLE f <br /> MEASUREMENT <br /> PERMIT ?- <br /> REQUIREMENT f.. <br /> SAMPLE <br />Q? I <br />' <br />A <br /> MEASUREMENT tit <br />\, <br /> PERMIT <br /> REQUIREMENT <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER I relit, ++ndrr pen:du of Iaw that Ihi% d-nnent and ,dl amichment. were <br />m ed umlrr m. dir",n or .a <br />ed kwo in accordance with a stern drei <br />rr <br />n d TELEPHONE DATE <br /> p <br />p <br />p <br />g --- <br />? <br />- <br />.'h <br />i •i <br />F? to a-sere that yualifted prnonnel pruprrh gather and evaluate the information --? o-.-?-- <br />' <br />' - - ` - ' <br />. <br />?. ?ubmilterl. lia.ad nn in, Iml+nn of the per-'or W-., who .-SK the -tem. <br />- :h- prr.on. dire.th rr rmonaihdr for gathering the informaton, the inrornatiun <br />W ?, <br />r - <br />- - <br />?- , <br />wbmilim 11. In be h.ra of m+ I.powledgr and belief. true. accurate, and -mpletr. - ? f j <br />- J J f••t }}•' i? <br />. <br />_ I ant aware that (here aresignirirant <br />enalties r(lr ?llbmlttin <br />fats inrur ntin 1 SIGNATURE OF PRINCIPAL EXECUTIVE <br />OR PRINTED <br />TYPED p <br />g <br />, <br />including the M-ihtliry of fine and innPrnonnlrnl for know ing ` it"tions. OFFICER OR AUTHORIZED AGENT AREA NUMBER <br />CODE <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />EPA Form 3320.1 (Rev 3/99) Previous editors may be used. This IS a 4-part foml.