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PERMITTEE NAMEJADDRESS ehrchu4, FaJir NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />NAME DISCHARGE MONITORING REPORT (OMR) <br />ADDRESS <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />FACILITY YEAR MO DAY <br />LOCATION FROM nnn TO <br />Form Approved. <br />OMB No. 2040-0004 <br />)ASH <br />9L.(NIN <br />NOTE: Read Instructions before completing this form. <br /> NO. FREQUENCY SAMPLE <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> <br /> SAMPLE <br /> EA <br />UREMENT <br /> M <br />S <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT i <br /> <br />REQUIREMENT _ <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> UREMENT <br />A <br /> ME <br />S <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> REMENT <br />EA <br /> SU <br />M <br /> PERMIT <br /> REQUIREMENT <br />MEMTLE PRINCIPAL EXECUTIVE OFFICER I certify end, pcnalry of haw that this dtxumcnt and all .rttachmcnts were TELEPHONE DATE <br />NA prepared under my direction oar supernisum in accordance with a system designol <br /> <br />- / .' <br />" - " tit assure that qualified personnel properly gather and cs.dwite the information <br />suhmnt d Based on Iny Ingmrs o) the person or persons wh,i inarwQe the sysienL <br />the information <br />h <br />i <br />ti <br />n <br />i <br />f J - - -- <br />-- <br />--' "- <br /> ng t <br />e <br />n <br />orma <br />o <br />. <br />or those persons directly respororblc for gather .. <br />te' t the best of mj knowledge and W- let. we, accurate. and complete <br />aibmitted is SIGNATURE OF PRINCIPAL EXECUTIVE <br />r <br />~ -- . <br />I jen aware that there are significant pctmlms for submiuing false infortnanm'. OFFICER OR AUTHORIZED AGENT AREA NUMBER I YEAR MO DAY <br />TVDFII (1R PRINTFD I •r,-Imhrg the riossibihty of fine and anprnonmeni for knowing t wlauons CODE <br />I COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />EPA Form 3320-1 (Rev. 3/99) Previous editiors may be used. <br />