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<br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDESI
<br />DISCHARGE MONITORING REPORT /DMR)
<br />PERMIT NUMBER DISCHARGE NUMeEn
<br />MONITORING PERIOD
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<br />Form Approved.
<br />OMB No. 2040-0004
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<br />NOTE: Read instruction before completing this form.
<br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO.
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<br /> ANALYSIS TYPE
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<br />NAME/TITLE PRINCIPA EXECUTIVE OFFICER = I certify under penalty o law that this document end all attachments were
<br />prepared under my direction or supervision In accordance with a system designed TELEPHON E DATE
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<br />`'+J e - U'?^'r " -. to assure that qualified personnel properly gather and evaluate the Information
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<br /> 1 am aware that there are significant penalties for submitting false Information SI ATURE OF PRINCIPAL EXECUTIVE f "L
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<br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. 00, 5P, / ( 'SPPW4-i, tWform. PAGE.
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