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PERMITTEE NAME/ADDRESS Ilnrlude FariGtr NameMocafian ij[Affrrentl <br />NAME <br />ADDRESS -- <br />FACILITY Zf7pp ,. <br />LOCATION F.: <br />WADE, '"'IF E <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES) <br />DISCHARGE MONITORING REPORT (D R) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved. <br />DMB No. 2040.0004 <br />i T RE <br />NOTE: Read Instructions before comoletina this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREOUE14CY SAMPLE <br /> OF <br /> EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <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 /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAMElnTLE PRINCIPAL EXECUTIVE OFFICER I rertif> under penalt. of law thus this document and 211 attachments weer TELEPHONE DATE <br /> prrpand wader mr direction or super,L ion in accordancr with u s)strm de igned <br />- - <br /> to assure lh., qualified prrWmnel pr,gxrly gather and rsw.te the information <br />- --- wbmitled. Based on my inquirry of Ihr ptnuu ar persons who man2Rr Ihr s)+trm. <br />t - or those persons dir ti% rapun.ibla for gaths-ring lhr information, the information <br />I submitted u, to the best of m1 knowkilge and twlkf. true, accurate, and -mpktr. <br /> <br />I am aware that there are si <br />nirkwnl <br />lti <br />f <br />r <br />h <br />ilti <br />f <br />l <br />ti <br />i <br />f SIGNATURE OF PRINCIPAL EXECUTIVE <br />- <br /> <br />TYPED OR PRINTED <br />,,.....r . r? A- -M. ....I-....- ...., ...... g <br />pena <br />es <br />o <br />su <br />m <br />ng <br />n <br />orma <br />a <br />se <br />on. <br />including the po++ibilits ur fine and imprisonment for knowing siolations. <br />.1.,. <br />OFFICER OR AUTHORIZED AGENT <br />AREA NUMBER <br />YEAR <br />MO - <br />DAY <br /> <br />EPA Form 3320.1 (Rev 1199) Previous editions may be used. This is a 4=part tcirm.