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PERMI7TEE NAMEIADDRESS (Include Faediq A'amr/Gtcarion if Different) NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS <br />G PERMIT NUMBER DISCHARGE NUMBER <br />FACILITY ZnNi i`1 1 MONITORING PERIOD <br />LOCATION YEAR MO DAY YEAR M DAY <br />.A C O ? FROM TO <br />Form Approved. <br />OMB No. 2040.0004 <br />?5RFIMJNF T)RNG TO TU <br />K1nTC. D.,nrt ir.nr.....r t...... 6...i..... .......... t..a:.... rt.... {...... <br />PARAMETER <br />I QUANTITY OR LOADING <br />QUALITY OR CONCENTRATION <br />NO. <br />FREQUENCY <br />SAMPLE <br /> >< OF <br /> <br />AVERAGE MAXIMUM <br />UNITS <br />MINIMUM <br />AVERAGE <br />MAXIMUM <br />UNITS EX ANALYSIS TYPE <br /> SAMPLE <br /> MEASUREMENT. <br /> PERMIT - _ , <br /> REQUIREMENT' 3QLiA :: 'LILY <br /> SAMPLE <br /> MEASUREMENT( <br /> PERMIT --- <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT f- REPOR7 _ 77 <br />:.. <br />sr; <br /> REQUIREMENT 2 DA DA I I <br />V <br /> . <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT `?AILY MX <br /> SAMPLE <br /> MEASUREMENT <br />1. 0 PERMIT F77PORT 777 <br /> <br />- REQUIREMENT L 't'! i_Y MX I7, <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - r <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certih under ranulh of Iu% that this document and an auarnmrnrs were <br />d TELEPHONE DATE <br /> prepare <br />under m? direction or supersisiun in arcordanu with a system designed <br /> o assure that qualified personnel properh gather and r%uluatr dm information <br />-- suhmitld. Rased on m) inquire of the per on or persons who manage the systrm, <br /> or Ihtnr Ixnans dirv"I.% responsible for gulhrring the information, the information <br />- submiu d is, to the best of m knowledge and belief, true. accurate, and a.mpirte. <br />I am aware that there are si <br />ifi <br />a <br />t <br />n <br />lti <br />f <br />b <br />i <br />f <br />l <br />SIGNATURE OF PRINCIPAL EXECUTIVE , - <br />TYPED OR PRINTED <br />rsnuucwaTn tin r . ?r w gn <br />c <br />n <br />pe <br />a <br />or su <br />es <br />m <br />tting <br />a <br />se information. <br />including the ponibilih of fine and imprisonment for knowing siodations- OFFICER OR AUTHORIZED AGENT AREA NUMBER <br />DE YEAR MO DAY <br />.?..? ..... ?..?...?...... ... r .... ......... ..... t• ...... ...wv .... aauoa.nn.ca.w nod c? <br />EPA Form 3320-1 (Rev 3/99) Previous editions may be used