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PERMITTEE NAME/ADDRESS iInclude Farility A'amdlLrarion if Differenti <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />!f <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 />MINOR <br />(SLIBR <br />F - FINAL fled <br />sr,&MINF L-RNG TRTB TO 1I.)i-'T'L_E OR <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 - . , .. r = .r , . <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ;i st y g r; <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT I N5T t`lA:' <br /> <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 />F <br /> REQUIREMENT <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER I certify under penult) of Iaw that Ibis document and all attachments were <br />d TELEPHONE DATE <br /> prepared under m. dirwtion nr wpersision In accordance with a ..stem designe <br /> to ussurc that yudlifled personnel property Kuther and es aluaa• the informatiom - - <br /> submitted. Hosed on my inyuirs 4 thr Wv n or persons who manage the system. <br />----' or thosa persons dire fl '% responsible for Knthering the information, the information <br /> <br />- submitted is, to the best of my km,whdgv and belief. true, -urate. and complete. <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br /> 1 am a%urr that there ter signifcani penalties for wbmitting false information. THORIZED AGENT <br />FFI <br />R <br />R A AREA <br />TYPED OR PRINTED inrludine the possibility or roe and imprisonment for knowing siidations. O <br />CE <br />O <br />U <br />I NUMBER <br />CODE YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />P FVFN <br />This Form 3320-1 (Rev- 3199) Previous editions may be used. is is a-I form. PAGE OF