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PERMITTEE NAMEIADDRESS !include Focilir? .Yamdl?xafiwi tf Dif fennel <br />NAME '•i <br />ADDRESS <br />FACILITY <br />LOCATION i,A <br />4'+ ER <br />LANCE WADE <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 />P! I NOR <br />c `1IJi1R Ml•f ) <br />F - FINAL Ni-S f R <br />5R&IIINF DRNG- TO TVTTLE DRAW <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY <br />OF SAMPLE <br /> EX 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 ter <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 Y . <br /> REQUIREMENT <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER I certiry under prnallq of luw that this document and all attachment% were <br />di <br />ith <br />d <br />d <br />i <br />i <br />i <br />i <br />d <br />d <br />i <br />d TELEPHONE DATE <br /> rect <br />on or wprn <br />on <br />n accor <br />a srstent <br />prepare <br />un <br />er nn <br />s <br />ance w <br />es <br />gne - <br /> a, aswre that qualified pc'nonnel properI% gather and rsalualr [be information <br />' - submitted. Ha" on m% inquiry of the person or pe")n, who manage the .stem, s <br />i <br /> or those penons directly respmnihk for gathering the inrormation. the information " <br />' submitted is <br />In the best or m's knowledge and holier. true, accurate, and complete. <br /> . <br />I <br />h <br />i <br />ifi <br />l <br />i <br />f <br />b <br />i <br />i <br />f <br />l <br />i <br />f <br />ti SIGNATURE OF PRINCIPAL EXECUTIVE -" <br /> <br />TYPED OR PRINTED or su <br />se <br />am .ware t <br />at three arc s <br />gn <br />cant Pena <br />t <br />es <br />m <br />tt <br />ng <br />a <br />n <br />orma <br />on, <br />including the possibilith of fine and imprisonment for knowing %iolationc. <br />OFFICER OR AUTHORIZED AGENT AREA <br />ODE NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS ANU EXPLANAIIUN Ut- ANY VIULAIIUNZ; (f•ferelence air anacnmefAS ne/e/ <br />LIMIT APP! 1 E1) FOR ! OYR/24HR PREC IP EVENT - SEE i A.2, <br />TiCri? - I. C. I0, t?G 20. 30 DAY AVG IS HIGHEST MO'-\)THLY <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. ^ ` This -is'a 4-part form.