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PERMITTEE NAME/ADDRESS flwwt Fanlin r?atnr;l urnfinn y bijf•renh <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />I <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />FROM YEAR MO DAY TO YEAR MO DAY <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. <br /> <br />EX FREOUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT F <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 cenih under panalti of law that this document and all attachments wrre <br />m or <br />isio <br />co <br />d <br />with <br />scste <br />cl si <br />a <br />d u <br />de <br />nn dir <br />vli <br />u <br />in <br />nc <br />d TELEPHONE DATE <br /> pmp <br />rc <br />n <br />r <br />t <br />i <br />s <br />prn <br />n <br />ac <br />r <br />a <br />e <br />a <br />m <br />gne <br /> to a.<wre that qualified pe-r nel pr lierl- , Lather and caulurle the information <br /> submitted. Based in my Inquin of the perwn or penans wha manage the a.drm. - <br /> or Iho.c lu.•nons dinc117 responsihlr for gathering the information, the information <br /> whmiticd K to thr hest of m) knowledge and belief. true. --tc. and umpiec. <br />w <br />altity fo <br />submittin <br />fake i <br />fo <br />I a <br />th <br />s th <br />ar <br />i <br />nirk- <br />t <br />m <br />lion SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED OR PRINTED m a <br />are <br />i <br />ere <br />c s <br />g <br />an <br />pen <br />r <br />g <br />n <br />r <br />a <br />. <br />including thic pi-ihilit% of fine and imprisonment fur knowing siolutioas. OFFICER OR AUTHORIZED AGENT AREA <br />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 3199) Previous editions may be used. This is a 4-part form.