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PERMITTEE NAMEiADDRESSnm*.&F@r&aHxa.WL«NtauDWWmoo <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />NATIONAL POLLUTANT DISCHMGE ELIMINATION SYSTIM INPDES/ <br />DISCHARGE MONITORING REPORT /DMRI <br />PERMIT NUMBER 04SCHAAGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved <br />OMB No 2040.0004 <br />NOTE: Read Instrucdone before completing We form. <br /> <br />PARAMETER <br />QUANTITY OR LOADING <br />QUALITY OR CONCENTRATION NO <br /> <br />NO. <br /> <br />EX <br />FREQUENCY <br /> <br />OF <br /> <br />SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> <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 /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />NAME/TiTLE PRINCIPAL EXECUTNE OFFICER t "nnr under pen¦ y e law that this dorumem and dl attachments we" TELEPHONE <br />tl <br />vi <br />i <br />I <br />ith <br />st <br />n d <br />i <br />d <br />d DATE <br />on <br />.n w <br />• ty <br />er <br />es <br />gne <br />Prepared under me dlrrr <br />on or super <br />s <br />n accor <br />I <br />h <br />f <br />ormatlon <br />to enure that qualified personml property gather and evaluate t <br />e <br />n <br />- , sabmllted. Bred on my inquiry of the person or persons who manage the tyslem, <br />, dir <br />m <br />omlbte for <br />atherin <br />the information <br />The Information <br />tl <br />th <br />ose person <br />p <br />g <br />g <br />. <br />or <br />ec <br />y <br />- /-... . -- „_ i. - • submitted b, to the bet of my knowledge and belief. Irate, -"W and complete. <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />" <br />< - m <br />t .m aw.n that ere are significant penamrs for submittint rain Inrormatlen, <br />A AEA <br />TYPED OR PRINTED Irwh ding the poalbinty of nne and imp Aaom ent for knowing rtofauo OFFICER OR AUTHORIZED AGENT CODE NUMEIER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS /Reference aN attachments hare) <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used This is a 4-part Corm. PAGE OF