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PERMITTEE NAME/ADDRESS (include Facility \mnelLocation if thfferent) NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />FACILITY 'Alin )`i i ,_"L `_ YEAR MO DAY YEAR MO DAY <br />LOCATION F N FROM TO <br />tJ nr,n ar: <br />Form Approved. <br />OMB No. 2040-0004 <br />MINOF <br />D--I-i^ TM T'R79/gRA557y CREEV= <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ, 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 />v <br /> MEASUREMENT ? <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE - <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE _ <br /> MEASUREMENT <br /> PERMIT ..? <br /> REQUIREMENT I <br /> SAMPLE <br />I - <br />I I <br /> MEASUREMENT (, "' <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE - <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER I certify under penwi, at law that thi, document and all alt.,hmvnt, were TELEPHONE DATE <br />prapand under m? direction nr upe %w,-n in -rdanco with a -tem derizned <br />to -ore that yualiti d pre )nnd PropcrI% gather and -aluate the inRarnwion <br />.uhmill d. Raxd on m% inquiry d the pt•r,on or w-n, who nonage the -tem. C <br />or tho,c I-- directl, rr,pm,ihlr for gathering the information. the information <br />) <br />whpiumd i,. to the 1-1 ur - knowledge and lwfi%-L true, aavurate, and complete. <br />SIGNATURE OF PRINCIPAL EXECUTIVE i <br /> I am a"'." thdl there are significant Itrnahlr, Grc,uhmitting rape inrormati,m. <br />t i <br />t r <br />i <br />vi <br />tio <br />% <br />r n <br />i <br />k <br />l <br />OFFICER OR AUTHORIZED AGENT <br />I AREA <br /> <br />NUMBER <br /> <br />YEAR <br /> <br />MO <br /> <br />DAY <br />TYPED OR PRINTED or <br />now <br />ng <br />o <br />a <br />n <br />in.ludm: th, ro-ibdil) w <br />ne aru <br />mpr <br />%mimen <br />. CODE <br />COMMENTS AND EXPLANATIUN UF' ANY VIULA I IUINS (Hererence ate arracnmenrs nere) <br />IP EVENT SUBJECT TO BURDEN OF PROOF IN I.A OIL &. <br />EPA Form 3320-1 (Rev. 3•99) Previous editions may be used. J0342/C'Thi%?is a 4-flail form.