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PERMITTEE NAME/ADDRESS,I,:, ;N.i, F:,, ri:r ' . „ .- a •.n r ,'„JJr-rrrtr <br />NAME <br />ADDRESS <br />FACILITY - <br />LOCATION, - <br />i-: njc:, <br />Al'4AGER <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MID DAY YEAR MO DAY <br />FROM TO <br />Form Approved. <br />OMB No. 2040-0004 <br />3- <br />RDLAf <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT ?? > '• <br /> SAMPLE <br /> <br />- MEASUREMENT <br /> PERMIT F E1- <br /> REQUIREMENT <br /> SAMPLE <br />r •: { ?,?;: L } MEASUREMENT <br /> PERMIT <br />r3C•L! REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - <br /> REQUIREMENT <br /> SAMPLE <br />- = MEASUREMENT <br /> PERMIT x ... <br /> REQUIREMENT AV <br /> SAMPLE <br />E'RA13L: MEASUREMENT <br />' PERMIT ... .. , j IF r-- j <br /> REQUIREMENT r ;'- ,' ; ?i <br /> SAMPLE <br />- - ;' , "- MEASUREMENT <br /> PERMIT .<.-? ..,_._ T r•- : . .: <br />' REQUIREMENT ? '' • ` <br />NAME(rITLE PRINCIPAL EXECUTIVE OFFICER I cemfy under penalt% ul ljU that thi, dPihanent and all attachments WL., TELEPHONE DATE <br /> prcparr 1 under my Jtrccnon or super. i ion in ucorlance with a cyucm de;tgned <br /> to assure that qualified personnel pn,perl% gather and e,•alunte the inf.mmnon t- <br />- submittal. Baued on my inquire of the person or perwns who manage the system. <br /> or thole perwns dhrcctly resNnstble for gathenng the mfomiation <br />the information <br /> , <br />L submitted is, to the hest of my kuow ledge and hchef, true. ac:urate. and complete. <br />i <br />i <br />t <br />d <br />h <br />h <br />f <br />l <br />f <br />b <br />i <br />f <br />k SIGNATURE OF PRINCIPAL EXECUTIVE - <br /> <br />TED <br />R ,m' <br />icant pena <br />es <br />tting <br />n <br />mma <br />I ,n aware t <br />at t <br />ere arc signi <br />t <br />or su <br />m <br />a <br />e <br />l <br />di <br />h <br />f fi <br />f <br />k <br />l <br />b <br />li <br />d i OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br />TYPED OR P <br />IN no cmg .,n <br />nu•- n>. <br />e possi <br />i <br />ne an <br />mpnwnmcnt <br />x <br />nc <br />u <br />ng t <br />ty o CODE <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />OF <br />rt to l ill. PAGE <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. III,, Is :I 1- ,;