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PERMITTEE NAME/ADDRESS it d- Jr ttvNm.?Lxarran lfDtirmt) <br />NAME <br />ADDRESS <br />FACILITY <br />LOCA Tx)N <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (INPOESI <br />DISCHARGE MONITORING REPORT (DMRJ <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 />NOTE: Road Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREOUENCY SAMPLE <br /> <br />EX OF <br />YP <br /> ANALrsts T <br />E <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> <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 /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />I "rWy r r prn¦ ly o aw that Ihh doej iw 1 .nd ¦0 ¦11Kh-L, were T <br />ELEPHONE <br />NAMElfiTLE PRINCIPAL EXECUTIVE OFFICER <br />- <br />1 <br />i <br />DATE <br />- or _p,_ <br />Prep¦red rndtr Te d <br />-1 <br />W_ In accord¦nrr .Ith ¦ svetem dedj wd <br />Y i to mur' I%" au¦Nfled p¦nonnN P HI talk- and evaluate the <br />Inform¦1bn <br />..brdtlra. sees en my Ir q.try of the Peron or Par who n .a(' the ayatrrrt, <br />Of Ihoat Prr¦om dinelly repordbk roe (.thrrrnt the Info-m¦uon, the Inrorrruuon <br />' <br />. <br />`. ? . ,J1 . <br />, ?.•L ?/ mbmllted K to the bet of my knowkd(e and bt*e. 1, ¦ecunlr. and eornpkte. <br />? : <br />I -- ¦..are U¦I IhfR am al <br />nlRun/ <br />rn.IMe for <br />bnrltl <br />t10NA TUBE OF PRINCyPAI EXE E:InTVI: <br />f <br />h <br />Inror <br />Il <br /> ( <br />p <br />m <br />n( <br />a <br />e <br />m¦ <br />on, <br />TYPED OR PRINTED +neh.d+n( 1k Poadbnlty orflnr and Irrprlsonmml for kno.In( vlar¦uon> OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR ?AO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference aN•rtec;Imentshere) PRECFP EVENT IS CLAIMED. II CLAII^. BY W)CD. <br />EPA Form 3320-1 (Rev 31") Previous edibons may be used This is a 4-pert form. PAGE OF