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PERMITTEE NAME/ADDRESS ir,d„dc Farifin ,vrrnc Lrxarrt», t ,/, . r? <br />NAME <br />ADDRESS % R AL O MIN <br />`FL , <br />FACILITY <br />LOCATION y <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPOES) <br />DISCHARGE MONITORING REPORT (DMR) <br />11 <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 />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO• OF FREQUENCY SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ; hr_;' 13R <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT a : T E P QF T Y <br />.-' tv ai ; ;' REQUIREMENT r;?:'L> L. f': = <br /> SAMPLE <br />' r_l: C'Jt: +t:Ai" t: (? :'_• c r- ', MEASUREMENT <br /> PERMIT 1 _ :, •. ; 't `•'L. <br /> REQUIREMENT <br /> SAMPLE ) <br />f''v- - ;_ MEASUREMENT <br /> PERMIT - R. RA13 <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT 't r } . <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT t f tx RAF'., r •'1 . 13 <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT t , .. r <br /> REQUIREMENT ' .' <br />NAME?1TLE PRINCIPAL EXECUTIVE OFFICER I .crtif% under penalty of law that this document and all anachments were TELEPHONE DATE <br />= prepared undr. my direction or supenuton to accordance wnh a system dectgne<l <br />-j to assure that qualified Pernnnel properly gather and evaluate the information <br />r submitted. Based on my inquiry of the Person or per.cru who manage the +y>tem• y , <br /> or those persons dttectiy respoutstble for gathering the inGxntadon• the information <br />- ?r submitted i., to the best of my knoslcdn and tr icf. true, accurate, and complete. <br />th <br />h <br />< <br />w <br />,du <br />l <br />e inf <br />r <br />tio <br />lk <br />f <br />b <br />in <br />f SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />P <br />I <br />TED crc arc <br />tgnt <br />., <br />e <br />cs <br />I mn aware <br />at t <br />or su <br />m <br />tng <br />a <br />s <br />o <br />ma <br />n. <br />hd <br />f f <br />t f <br />ti <br />d <br />k <br />i <br />i <br />t OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br />TYPED OR <br />R <br />N or <br />now <br />ng v <br />its. <br />mchtdmg the p, s <br />in o <br />ine an <br />!rn; n,omnen <br />o <br />a CODE <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />EPA Form 3320-1 (Rev. 3,''99) Previous editions may be used. 7Q(j r This is a 4-part form.