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PERMITTEE NAMEIADDRESS r/naude Farilill Nam, 'l. , u,.m !ri/prnu NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />NAME DISCHARGE MONITORING REPORT (DMR) <br />ADDRESS <br />PERMIT NUMBER DISCHARGE NUMBER <br />FACILITY MONITORING PERIOD <br />LOCATION YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved. <br />OMB No. 2040-0004 <br />MI <br />it <br />c <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION N0. FREOUENCY SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <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 i' <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certif. under prnalh of law that this document and 211 attachments were <br />prepared under m <br />dir xlion or su <br />ea,ision in wcordance with a ...ten desi <br />ned <br />TELEPHONE <br />DATE <br /> l <br />p <br />g <br /> to assure that yualirled prrconnel properl'i gather and et aluate the inrornalion - <br /> submitted. Based on m% inyuir) or the person or persons who manage the,.stem <br /> or those persons dirrctls responsible for gathering the information, the information <br /> submitted is, to the tw-.t or m? knowledge and Iw•dirr. true, accurate, and wnsptelr. - <br />- I.. aware that there arc significant <br />11- Lo .ubmitlin <br />ro <br />faly information SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED OR PRINTED p <br />. <br />g <br />. <br />-iudinx the pondbiiib of finr and impri...nnent for knowing iodations <br />OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />OD <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. This is a 4-part fomi.