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Ibirlude F'acilitt Aamell.ocation if iNfferentj <br />NAME <br />ADDRESS <br />FACILITY t (... < :. _ I'1 l i'v <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 />MI;: _ <br />F <br />?.??(i•iI IUE 1JtY [4t i _ i_iT i l_ ? !_''<rjw <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 /> AN <br />ALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> .REQUIREMENT 1 Y i'1:.'M <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT " <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br />PERMIT z r =. <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br />PERMIT or . ,. . x r _ _ <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAMEITITLE PRINCIPAL EXECUTIVE OFFICER I certif. under penalty rd law that this do rumenl and all attachment, -em TELEPHONE DATE <br /> prepared under m) direction or, svpcrs kion in accordance with a s)strm d.signed <br /> to a+w.rr that qualified personnel proWd., gather and evaluate the information <br />t <br />- - -- - +ubmitttd. Bated on m) inquire of the pemal or persons who manage the s)stem. <br /> or those persons dinctl) responsible for gathering the information. the inftKmalion <br />- <br />• submitted is, to the best or ms knoetledge and Arlie(. true. accurate, and complete. <br />SIGNATURE OF PRINCIPAL EXECUTIVE " <br /> 1 am aw arc that then arc significant penalties for suhmitting fWw information. AREA <br /> risonment for knowing violation, <br />the <br />ssihilit <br />)(fine and im <br />di <br />i <br />l OFFICER OR AUTHORIZED AGENT NUMBER YEAR MO DAY <br />TYPED OR PRIN D ) <br />p <br />nc <br />u <br />ng <br />p <br />I CODE <br />COMMtNIS ANU tAVLANAIIUN UI- ANT VIOLAIIUNJ (riCf@lanr:r all actacr,rr,ants rune/ <br />LIMIT APP!_IFU FOR 10'•/R/224HR PREGIP EVENT - SEE I. N. 2, <br />30 DAY A`JG T S H I GHES-r MCN i'H_Y <br />T IONS - I C . ? O, Pt; 20. <br />EPA Form 3320-1 (Rev. 3/99) Previous eddions may be used. This is 'a 4-part fbrtll.