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PERMITTEE NAME/ADDRESS (/.,lode fdnlip ,Nom.,/-atunr rt 1,;q-, m <br />NAME <br />ADDRESS <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 />(SUBR JC) <br />F - FINAL <br />+?RFr:c RUNOFF rO TIR <br />Form Approved. <br />OMB No 20400004 <br />NOTE: Read Instructions before completing this form. <br />TT <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUFENCY SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE I/4 YI Std <br /> A <br />EM <br /> ME <br />SUR <br />ENT <br /> <br /> <br />PERMIT <br />h . <br />? <br />bO?ti <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 certir% under twnalt% td few that this document and all attwhtnr.U %err TELEPHONE DATE <br /> pnparrd under my direction or solo. bion in act urdwwe with u s7 stem designed <br />r <br /> to a>,.?tre that yuaiified personnel properh gather And rr ulaate the information -- - - ??? <br /> submitted. Na.ed o t m? inyuin,d the person or persons who manage the yatem. _ <br /> or those petwms direedi responsible ror gathering the information. the information <br />- d t <br />li <br />f <br />c <br />r <br />t <br />a <br />d co <br />lrta <br />L <br />d <br />- <br />L nnwle <br />, inw. ac <br />u <br />a <br />e, <br />n <br />mp <br />submitted is. In the hest o.f rm <br />ge an <br />w <br />r SIGNATURE OF PRINCIPAL EXECUTIVE <br />. <br />- 1 am uwarr that there arr.ignifwant penalties for.uhmitting faLse information. AREA <br /> risonmrnt for Ism-ing siolation <br />ossibilit <br />of fine and im <br />i <br />l <br />di <br />the OFFICER OR AUTHORIZED AGENT NUMBER YEAR MO DAY <br />TYPED OR PRINTED . <br />p <br />nc <br />u <br />ng <br />p <br />y CODE <br />COMMENTS AND EXPLANATION VF ANY VIULAIIUIVJ (Reference all arfacnmeni5 nere/ <br />EPA Form 3320-1 (Rev. 3139) Previous editions may be used. O ?. This is a 4-part form.