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PERMITTEE NAME/ADDRESS One"FswryNa.WL-Wton((D(Qlwswr) <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION Sr STEM frNPOESI <br />DISCHARGE MONITORING REPORT (OMR) <br />PERMIT NUMBER aSCHMOE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved <br />OMB No 2040-0008 <br />NOTE: Reed I nrtructlone before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. NCr <br />FREOO SAMPLE <br /> EX F Y <br /> ANAtrsts T <br />PE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> <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 />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER I ren,lr -d- penalty o law Met th is donment and all ,uarhm eno were TELEPHONE DATE <br /> prepared under my dlrertlon or mia ",hloeu In ,crordance with • system, dea!`ned <br />. ! to aawre that quanned personnel properly gather and teduete the Infonnetlon <br />submitted. Bawd on my I".try *(the person of per who menete the system, <br />/ i <br /> or throe persme dimctty rvpomtble for g,thertng the Infornatlom the Intornsdon <br />- <br />J ! - ,' - '- - -- wbmltted Is. to the belt of my knowledge and belief. true, se-rate. and cornplHe. <br />t on, aware that then: are srtrdrl-l <br />enahlrs for wbmttttn <br />Satre Inform <br />tio <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br /> p <br />g <br />a <br />n. <br />TYPED OR PRINTED in-tvd'ot the poalbtltur of nor -i imp,isonmrot for knowing .W.dens. OFFICER OR AUTHORIZED AGENT CAE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference eM attachments herel <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. This is a 4-part form, PAGE OF