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?ERMITTEE NAME/ADDRESS(7-&&F.ewfyN-61-.tt-((D(#;e-,) <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION I- R <br />Ir` Y i 5AND'ER`3, -: t OF. <br />NATIONAL POLLUTANT DISCHAROE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT /DMR) <br />PERMIT NUMBER asCHAROE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved <br />OWZ No 2040-0004 <br />NOTE: Reed Imtrucdorw before completing thla fofm. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, <br /> <br />EX FREQUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT -? - l <br />. ; i•! I",; <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 />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER ' n~tll ° r penalty *(law that this docmment and all .ltachnw is wee. TELEPHONE DATE <br />pmpamd under my direction or fupe 11 on In atcordan- with a frftetn de4Rned <br />to sere that gvanneel personnel proWy gather and eealuate the Informatln <br />- submitted. Bawd on my inquiry *((I* person or prnorn who -age Ow system. <br /> <br />or those prrapm dimly respo"We fa gathering the Info tlon, the Information _ <br />submitted Is, to the bat of m7 kmwiedge and beW, Irve, securate. and complete. <br />EIONATURE OF PRINCMAL EXECUTIVE <br />' <br /> 1 am aware that there arc dgnincawt penalties for submitting fakir Information, AKA <br />TYPED OR PRINTED Including the possibility of Mm and Imprisonment for knowing rlolstsoets. OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS IRderence aM attachments hare) <br />IF .LAIN APPRU'v'?=?? i1' WC1(:i. <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used This IS a 4-(kart form. PAGE OF