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PERMITTEE NAME/ADDRESS(Yn-iir FwrWty Nmaa/Lx«tem(/Du%,wu) <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION t: Ft [ <br /> <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM frNPOESf <br />DISCHARGE MONITORING REPORT IDMRI <br />PERMIT NUMBER ascHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY Y AR MO DAY <br />FROM TO <br />Form Approved <br />OMB No 2040.0004 <br /> <br />NOTE: Reed inotructione before completing thle form. <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 ;. <br /> REQUIREMENT I MUM <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ,. J <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT E_'! <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT _1 _T 757 ?z <br />,. <br />_ . <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />77' 1 7' <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT .:. .. <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />t re n, r Prna y o s. that NN if r r rm and .11 attachments rect. <br />NAMElTITIE PRINCIPAL EXECUTIVE OFFICER TELEPHONE <br />. <br />DATE <br />prepaml coder my dlrxnan or super.4slon In accordann with • system dtdjnd i . <br />to a m that qualined personnel properly tether and reahtate the Infnrmatlon <br />benlited <br />1 "wiry <br />m <br />? <br />. <br />bbk ? <br />dlrec <br />y <br />hl erinthee Inf-rnallon, the Igor, ?.tb <br />(hoar „ <br />i 7 submllted Is, to the Lest of my kmawlydge end belief, true, a role, and r plett <br />I am .wars that them an 0 <br />ninuml <br />enalties for <br />bmtln <br />(els <br />SIONATVRE OF PRINCNAL EXECUTIVE <br />Inf <br />no <br />' <br /> 1 <br />p <br />ar <br />ng <br />e <br />orma <br />n. AAEA <br />TYPED OR PRINTED to -hrding the potdblllty of nor and Imprisonment for kno.lnE vW*tk"m OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS /Reference &M iffechmenta here/ <br />EPA Form 3320-1 (Rev 3/99) Previous editions may be used. This is a 4-pan forTn. PAGE OF