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PERMITTEE NAMEtADDRESS: Include Fncifitt V'ame/lin•nri,rn if lhffrrenb <br />NAME , <br />ADDRESS ??. <br />FACILITY <br />LOCATION <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <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 />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT 1 , <br /> 1 <br /> PERMIT sr <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 <ernfr ?MIf! Iw n.dn ,.t i,rrr thel chi. d,wwmem wwl ali mturhmenl. wed • <br />rfi <br />- <br />-i nwl <br />r m <br />ti <br />m <br />r <br />n <br />•i•i <br />in <br />d <br />i <br />h <br />d <br />i <br />TELEPHONE <br />DATE <br /> i <br />ila <br />, <br />re• <br />, <br />a <br />. <br />ix r <br />wn <br />uer„r <br />aner w <br />a .•.Irm <br />; tav <br />e <br />t <br />e. I <br /> In a..wo duU ,prdlifird Ixrwnnd pn,yrt, L:dhcr .uul rr:Juatr Ibe inb,rmalinn ? f <br />- - ? j . , ?._ .uhmiurd. Ra.rd on m• mgmry of the Ixr.,m err Ixnm. who nwneLr thr .•.Iem. ? J <br />- ..r 11,-. fwn Ii-, [I, rc•pm.ihle fur Lalh-mg the inrm-awn. the in fwrmatinn . <br />I <br /> .ohnnlhvl I•. L, the tx-a ul nn Ann•Hedg , nd Ix- id. m. - wretr. end umplel•. - <br /> 1 am award Ihet Ihen- erv.lanirnvrn p-jifie, r,w -b-i inL• f d.e intarmeti,m SIGNATURE OF PRINCIPAL EXECUTIVE <br />TYPED OR PRINTED , <br />indudme Ili, Iw .ihilin wf rind end -,I....,,nmeni f,.r Ln„••in, •i,d:dn,n OFFICER OR AUTHORIZED AGENT REA <br />CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />I f,4G : NSTR!JC T I ON'- - 3t=_'` 1. C. <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. O0O19J CjbL, is a 4-parl loan. PAVE OF j