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a <br />PERMITTEE NAMEiADDRESS dri, lude lacdinNamet,k-ation r/Di(lenna NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) , ....... <br />NAME DISCHARGE MONITORING REPORT (DMR) OMB No. 2040.0004 ; <br />r' <br />ADDRESS <br />PERMIT NUMBER DISCHARGE NUMBER T <br />FACILITY MONITORING PERIOD .Vlp , <br />LOCATION YEAR MO DAY YEAR MO DAY <br />FROM TO ? <br />NOTE: Read Instructions befor completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY <br />OF SAMPLE <br /> TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> <br />REQUIREMENT T I.; <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT r + # aitr l?a? ?;? WICF;- -•RAC, <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT F # •. ;: r. ,_ is ,. ?: F C I R T t_+. 5 ! ar`A1 <br /> REQUIREMENT 3?DA AV'C <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT sr )t;rr rfii;; ,; a: t .-as , (}V?t s #s• , W I C E ?RR AFl <br /> REQUIREMENT .30Dr+ A ; <br /> SAMPLE - , <br /> MEASUREMENT <br /> PERMIT ti. it a ## r h - Tr ir.: i= r ;, itf r iF -- I tj EivT 1 iV 'f rih <br /> REQUIREMENT T_I'vT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT REPORT Rif (7R ' ? . t•s3E# s: i ;, i,1 T IN • L?, :ID <br /> REQUIREMENT ;rDA I?VG DAIL.Y C` <br /> SAMPLE ,- <br /> MEASUREMENT <br /> PERMIT ,;...: :; #. t .•o ;... !; EFOR (' REPORT T :?rtr <br /> <br /> REQUIREMENT ^•?`)tT AV•^ DAILY °I:' <br />NAME TITLE PRINCIPAL EXECUTIVE OFFICER I Lenify under Penalty of tan that this document and all atwchtncnts were TELEPHONE DATE <br />n(11s ones prepared under my ducction or supra t-inn in accordance with a svsteni designed <br />l <br />l <br />h <br />f <br /> ormation <br />to assure that ytmlified personne <br />properly gather and eva <br />uate t <br />e in <br />f + <br />Hyft"i6t I submitted. Based on my inquiry of the pce?on or penotu who manage the system, I <br /> or those pervms dtrraly responsible for gathering the inf.umwtton, the mfrtnavon <br />276-5209 tuhmrtted ts, n• the best of my knee Iedgc and hch l n.i t urntL -m 1 - mplnr. <br />I m, aware slat there are swruficaw <br />enaln , + r d ip f sc t r i <br />t <br />wn <br />SIGNATURE OF PRINCIPAL EXECUTIVE d <br />0 <br /> . <br />p <br />. OFFICER OR AUTHORIZED AGENT AREA <br />TYPED OR PRINTED nctuding the;,owbilny of tine anJ impn-,n-i t, NUMBER I <br />CODE YEAR MO <br />COMMENTS AND EXPLANAl IUN UI- ANT VIULAf IUNa (rrererence an arracnmenrs nere) <br />7CIP EVEi\IT sJF',!ECT TO BVRDEN OF PP,013F REOUIREME1 <br />I THE 1)1VI5310N WITHIN 40- HOUR <br />EPA Form 3320-1 (Rev. 199) Previous editions may be used. hi, w a 4-part fDfm.