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l '"i'•tdITTEE NAME/ADDRESS /lndrdcFuc'nlut Vume.2«•iutvnillJ!(je?rrl <br />ME <br />ADDRESS -): <br />FACILITY <br />LOCATION <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPOES) <br />DISCHARGE MONITORING REPORT (DMR) <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 />it I NOR <br />( SIJ8R d?W ) <br />F - FINAL T? <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />li REQUIREMENT M ON I i <br />. <br /> SAMPLE <br />1" l MEASUREMENT <br /> PERMIT "t?RT RE"ORI <br /> REQUIREMENT U =', I t_. ,t <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - <br /> REQUIREMENT ::. , . ,-H. <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT # its° ,• T ?t!JFiL. <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 I certify under penalty of Lm that this dtkurn mt and all attachments were TELEPHONE DATE <br /> prepared under my duecuon or suNmston to accordance wnh a system desivlucd <br />' - <br />' -' - t assure that qualified pcr.onnel properly gather and evaluate the information <br />bmtted B <br />ed on m <br />ir <br />of th <br />s <br />th <br />h <br />-- _ ? <br />?- " ' • > <br />- n: <br />as <br />y inqu <br />y <br />e parson or per <br />ons w <br />o manage <br />e system, a- <br />- ?- or those persents directly responsible for gathering the information. the inionnation - C <br />( ubuntted is. I,, the Lest of my knowlutee anti belief. true. accurate. and complete. <br />e th <br />t sh <br />1 <br />lt <br />f <br />f <br />l <br />i SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED OR PAINTED a <br />ail sinc <br />ies <br />or n fig <br />ntions <br />m. <br />irr ate fine and d pena <br />a <br />se <br />including the poxstbilny of fins an mupn„?nment for or knowing violations OFFICER OR AUTHORIZED AGENT <br />I AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br /> . <br />. CODE <br />GUMMtN15 ANU hAPLANAIIUN OF ANY VIOLAI IUNS (Heterence all attaCnments here) <br />EPA Form 3320-1 (Rev. 3/99) Previous editiors may be used. 00136 Thi* is.a 4-part form.