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PERMITTEE NAME/ADDRESS Nncrade Facilits .Vase/Location if Diffenarl <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION 31 E_ _s <br />"+1A01=R <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES) <br />DISCHARGE MONITORING REPORT (D R) <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 />t 5'_ <br />F <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, <br /> <br />EX FREQUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT i .. <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 /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER I g'r'it` umber benali °I law that this document and all altachntcnu were <br />re <br />ared under me di-tion or ca <br />er%kion in <br />ccordance with a s"sslem desi <br />ned TELEPHONE DATE <br /> p <br />p <br />p <br />a <br />g <br /> re that qualified peramnel pnga•ri) gatM•r and esaluate the inrormation <br />in -1 <br /> : <br />.uMnited. Rased on nit imluirs of the pervm or pemons who manage the system, <br />oar lhnse penorns direalt resprmsihle for withering the information, the information <br />j , <br /> submitted is. In the boa of m1 kmwlydgand belief, True, -uratrand nmpkle. <br />re that thera <br />lti <br />s fn <br />bmittin <br />fals <br />information <br />I <br />w <br />si <br />irKa <br />t <br />n <br />s <br /> <br />SIGNATU OF PRINCIPAL EXECUTIVE <br /> <br />`- <br />TYPED OR PRINTED am a <br />a <br />re <br />gn <br />n <br />Pe <br />a <br />e <br />r <br />u <br />g <br />e <br />. <br />including the pensibilio of rine and imprisonment roar knowing siolations. OFFICER OR AUTHORIZED AGENT AREA CODENUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />EPA Form 3320-1 (Rev 3/99) Previous edttions may be used. 0 ,, " nis is a 4-part "t`"Orm.