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PERMITTEE NAME/ADDRESS (Include Facility .Fame/Location if Differenl) <br />NAME <br />ADDRESS <br />FACILITY r`, NINE. COMPLEX <br />LOCATION <br />-?,1 <br />,. r, r: DiCt•`i nR::.TTrIiV 1?tAIVL?t':•FF? <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPOES) <br />DISCHARGE MONITORING REPORT (OMR) <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 />r? a <br />NOTE: Read Instructions before completing this form. <br /> NO FREQUENCY SAMPLE <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION . <br />EX OF <br />ANALYSIS <br />TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />I . <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT - <br /> <br /> PERMIT <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> <br /> REQUIREMENT <br /> SAMPLE I - - <br /> MEASUREMENT <br /> <br /> PERMIT I <br /> <br /> REQUIREMENT <br /> SAMPLE <br />i <br /> MEASUREMENT <br /> PERMIT <br /> <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> t <br /> PERMIT <br /> <br /> REQUIREMENT <br /> SAMPLE <br />` v <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME)TITLE PRINCIPAL EXECUTIVE OFFICER 1 certify under penatt> oflaw that uth document and au attachment. were TELEPHONE DATE <br /> prepared under my direction or.up r%ision in aa<ordance with a -tem designed _ <br /> n, assure that qualified personnel properh gather and e.ahwr the information <br />who m <br />the -trm <br />e <br /> , <br />ron or persons <br />anage <br />submitted. Rased on nq inquiry of the P <br />ersons directly resix-ihle for gathering the information, the information <br />or thine i _ <br />j I <br /> P <br />submitted is, h, the brsf of my knowledge and belief. true, accurate, and complete. RE OF PRINCIPAL EXECUTIVE <br />SIGNA <br />TU <br /> I am aware that them are sigmricam penalties for suhmitting rake information. AGENT <br />TH <br />I <br />E AREA <br /> <br />uncut for Avowing elolations <br />ihili <br />f fin <br />• a <br />d im <br />ri <br />i <br />l <br />di <br />h OFF <br />R OR AU <br />OR <br />Z <br />D NUMBER <br /> <br />CODE YEAR MO DAY <br />TYPED OR PRINTED p <br />e Pns <br />q o <br />a <br />n <br />s <br />nc <br />ng t <br />u <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments nere) <br />,.FD TO REQUEST A REASONABLE POTENTIAL ANALYSIS BE <br />This, is a 4-(tart fomi. PAGE OF <br />EPA Form 3320-1 (Rev. 3.'99) Previous editions may be used.