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PERMITTEE NAMElADDRESS,1- h.dr <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />a'.. [ (NP DES <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 />NOTE: Read Instructions before completing this form. <br /> <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION Np• FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />I MEASUREMENT <br /> PERMIT ?'.:: r_11FiL <br /> REQUIREMENT I(`j; T <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 />NAMEITITLE PRINCIPAL EXECUTIVE OFFICER I certify under penalty nl Inw that this document :md all attaLhments were TELEPHONE DATE <br /> prepared under my direction or supervision to aLCnrdance with , syaem designed <br /> <br />? <br />J to assure that qualified personnel pmlxrly gather and csnluate the information <br />-' - <br />' ! C " <br />.1 <br />o submitted. Based on my inquiry of the person or persons who m,magc the system. <br />ersona directly respon,ihle for gathering the information, the mfnmtation <br />or those - -- <br />- Ai? <br />_ p <br />subnuried is, to the best of my knnwicdgc and bel,et. true, accurate, and complete SIGNATURE bF PRINCIPAL EXECUTIVE r " <br /> I .m aware that there are significant penalties for.%uhmitting false nttormati,xt. OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br />TYPED OR PRINTED m.Iud,ng the posstbihn of fine and tmpri-rimcni for know,ng stnlat nos. CODE <br />GUMMLNI, ANU tAVLANAIIUN Ur ANT VIUt..Attvtvo <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. <br />v, -HR PREC IP. EVEPA i - SEE I. A. 1, PG. 3. = QR <br />;;AMP!- ING INSTRUCTIONS - I, C.. 7 , P(y. 14. <br />)C 17L- This is a 4 -part fomi.