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PERMITTEE NAME/ADDRESS tfndudr fariliny Naw incetian if Utfferrnfr <br />NAME <br />ADDRESS <br />i 1 <br />FACILITY <br />LOCATION <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 />hlNTIRS <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO- FREOUENCY SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT _ ! _ - - <br /> REQUIREMENT I N5T MAX <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 ctrtif% under pens ate of lam that this document and all attachruenla were <br />d <br />I <br />d <br />i <br />d TELEPHONE DATE <br /> ance m <br />prepared under my direetion or super iaiou in accor <br />th a ai %tent <br />c- <br />gne <br /> to w"ure that qualified prmonnel properi% Rather and e%aluale the informatom <br /> auhmitted. Based on m} inquin of the peraiin or pervms mho manage the a.-wia. <br /> or thuar persons directly re+pornibir for gathering the information. the information <br /> mthmil d is, to the heat of m. knumledge and belier. true. accurate, and eompietr. <br />i <br />f <br />l <br />I <br />f <br />i <br />c SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED OR PRINTED I am .,mare that tbere are signifi <br />ant penaltita for submitt <br />ng <br />i <br />ar <br />n <br />ormat <br />on. <br />including the p-lbllith or fine and impriarmment for knoming siolatiom. OFFICER OR AUTHORIZED AGENT AREA <br />D NUMBER <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. Thos _s "e'?-part form.