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PERMITfEE NAMElADDRESS Ifni Jude Ford( •, None: U„ m„n d Niflerew <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPOES) <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 />Fcirm Approv <br />OMB No. 2040-0004 <br />(S <br />E <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. 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 /> 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 />NAMElrITLE PRINCIPAL EXECUTIVE OFFICER I certify under penalp of law that this document and all attachments were <br />d TELEPHONE DATE <br /> esigned <br />pmpund under my direction or supervision in accordance wilh r .Diem <br /> In assure that qualified I-nnel prnperit gusher and esaluale the information <br /> suhntill d. Bawd on m) inquire of the per- or person who manage the system. , <br /> or IN- pen,ats directly m%pnnsiMe for gathering the infurmation, the infurmatio. ' <br /> suhmilid k, w the hest or my knowladgc and belief. [me, accurate, and complete. SIGNATURE OF PRINCIPAL EXECUTIVE - ' <br /> <br />TYPED OR PRINTED <br />I 1 am aware that there arc significant penalties for suhmitting falx informatina. <br />including the pi,-ihilitl of Fine and impri-nmenl for knowing ciulalion? OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />CODE <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS <br />here) <br />BMIT A RF:GUES'T <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used- This is a 4-part form.