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PERMITTEE NAME/ADDRESS (Include Faciliq :\ame/lticarion if Pifjereru) <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION . <br />Cr1 S, I <br />F MANAGER <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES) <br />DISCHARGE MONITORING REPORT (D R) <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 /> MEASUREMENT <br /> PERMIT ., .. u . ;< <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 /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certify under penait> o! law that thi% document and all attacbwnth wrn• <br />prepared under m? direction or su <br />ervision in accordance with a s <br />stem desi <br />ned TELEPHONE DATE <br /> p <br />y <br />g <br /> to assure that qualified perc,mnel properi? gather and rs aluale the Information <br /> wbmittrd. Raid on ms iiuluin of the person or per ms who manage the .„tern, <br /> or those person* dirt-01 rrspem0)le for gathering the inrormubun. the information <br /> submitted is, Io the hr4 of my Isn-Ittigr and beb,r. true. a-urut, and complete. <br />I am aware that [here ire si <br />nificant <br />itie, fLr <br />h <br />Ed <br />inf- <br />itti <br />itwn SIGNATURE OF PRINCIPAL EXECUTIVE <br /> ,u <br />• <br />g <br />penu <br />m <br />ng <br />- <br />m <br />OFFICER OR AUTHORIZED AGENT AREA <br />TYPED OR PRINTED including the p-ibtlit% of fine and impri onnt,nt for knowing %n4a1j,-. O E NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />"i't_ I EIi F'OR ? I-'YR/24HR PREC IP rVENT - SEE I. A. 2, <br />_ I. C I0, PG 20. 30 DAY AVG IS HIGHEST MONTHLY <br />EPA Form 3320-I (Rev. 3/99) Previous editions may be used. 004 J. `.. Tfti0 s-44 -paft 4m.