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P E R M ITTEE NAME/ADDRESS i (ncludr Faci(ir) .\'amn'l a nrion .f Uiffrrrnr i <br />AME <br />ADDRESS <br />rACiurr <br />LOCATION <br />1-AW ._ 1Ii[ ! i 1r1r ;AGE <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 /> <br />;R&I-ITNE riRNG TCi TUTTLE UFF AW <br />NOTE: Read Inctrttrfinnc hafnra rmmnlafinn thin form <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY <br />OF SAMPLE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE <br /> SAMPLE <br />MEASUREMENT <br /> <br /> PERMIT <br />REQUIREMENT <br />;i; re <br />iR ' •=' ! <br /> SAMPLE <br />MEASUREMENT <br /> <br /> PERMIT <br />REQUIREMENT . > r _. t„ IL) t-T rr:_ <br /> SAMPLE <br />MEASUREMENT <br /> R <br /> PERMIT <br />REOUIREMENT = ., ., -; sri <br /> SAMPLE <br />MEASUREMENT <br /> <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br />MEASUREMENT <br /> <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br />MEASUREMENT <br /> <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br />MEASUREMENT <br /> <br /> PERMIT <br />REQUIREMENT <br />NAMEJTITLE PRINCIPAL EXECUTIVE OFFICER I centf) under penal[, of law that this document and all attachments were TE <br /> <br />prepared undrr m% dinvlion or %I,Wnision in accordance with a system designed LEPHONE DATE <br /> to assure that qualified personnel properl-s gash" and esalualr the information <br />submilitd. Based on my inquiry of the penon or perwms who manage the sl stem <br />or those penons directly respinsible for gathering the information. the information -- <br /> <br />- - <br /> submitted is. to the hest of ms knowledge and belief. Inte, accurate. and complete. <br />I <br />SI <br />N / , - <br /> am aware that there are significant penahies for submitting false information. G <br />ATURE OF PRINCIPAL EXECUTIVE -' % <br />TYPED OR PRINTED <br />COMMENTS AND EXPLANATION OF ANY vlnI including Ilse pssihility or fine and imprisonment for kmwing si,datioa, <br />ATIONG Mofaranra a(r nffenf....isneti t OFFICER OR AUTHORIZED AGENT AREA NUMBER <br />ODE YEAR MO DAY <br />FL-it''1I T5 WILL i <br />i 1--12 'FOR REQUIRFM1 <br />EPA Form 3320.1 (Rev. 3199) PfeviOUS edition may be used. TIT1S 1% a 4-part form.