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PERMITTEE NAME/ADDRESS p-tim4F.ewry Xa.?Lor.non{/D(j%..u) <br />NAME <br />ADORESS . <br />FACILITY <br />LOCATION <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM ((NP0E3I <br />DISCHARGE MONITORING REPORT (DMRI <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved <br />OMB No 2040-0094 <br />NOTE: Read Irmtructiom befori eorr?pletin9 this farm. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. <br /> <br />EX FREOUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANAlysls <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br />- <br /> PERMIT ? <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> <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 />NAME/T1TLE PRINCIPAL EXECUTIVE OFFICER ' renrly " ' °`". 1y ° I..r 1h.1 1hh decumenl .nd aH .Ita[nrnenlf were TELEPHONE DATE <br />prepared ender nay direction a eePerrNow In accordance rr111% ¦ fyoern delgm-d <br />to woure that QuaNlkd prr nei property gainer and eealuale Ins Info lbw <br />.abrnHled. Bred on my Inaulry or the person or penom .ho manage the .yslern. <br /> <br />or those ixr s dlrectly reaperrdbk for galhering the Infor tian. [be Inforrrutlon <br />. y- a+brnllled K to the beat of my Yno-ledge and bees!. Iru.. accuraw and cumpkle. <br />i - I <br />lrl <br />l <br />t <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />l <br />i <br />t - <br /> Penalties roc wbrn <br />am 4- ual IhM are a <br />gn <br />can <br />a <br />ng Wee <br />nrorrrutbn. AREA <br />TYPED OR PRINTED Including the poarbluly or Am and Irnprlaonrnenl f°r knowing .loietl ni OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference ON attachments hors) <br />EPA Form 3320-1 (Rev 3.199) Previous editions may be used This is a 4-part form. PAGE OF