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PERMITTEE NAME/ADDRESS Onclude Facifitn \nmr']-ari m it h?lfrnnt <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 />(Sl <br />F <br />M <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 <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />7 7 <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I vertirt under fernalu (if law that this el-mem and tell atWOhmenh weer <br />ith <br />d <br />i <br />d <br />d TELEPHONE DATE <br /> a sy-arm <br />prepared under my dirrelion ter tipr ision in accor <br />ance w <br />es <br />gne <br /> to wk ure that ywliriid f rramnri pruperl? Rather and r%aluutr ther information t _ <br /> suhntiltA. Ifased ,m my imluiry of the per-nor pr-ms who mange the s stem. <br /> nr those penons di-lli rola,nsihle for gathering the infterrwtem, the information - <br /> suhmiurd b, to the hest of my knowledge and helk•f. true. accurate, and complete. SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED OR PRINTED I am aware that them are significant penalties for submitting rake information. <br />including the p,nsibilits of fine, and imprisonment for Avowing siolations. <br />OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />CODE <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br /> <br />BMIT f: F E(lUE: T FOF <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. Thi% is a 4-part form.