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PERMITTEE NAME/ADDRESS p+rrb FarWeyAfanearLa ottow 1/D(ee of) <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />NATIONAL POLLUTANT 04SCHAAGE ELIMINATION SYSTDA ((NPOES/ <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NVIABER <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. <br /> <br /> <br />EX EGVENCY <br /> <br />OF <br />r <br />SAMPLE <br /> <br />TYPE <br /> ANALysi <br />S <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 />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER ' fe"t'y "'Ier pena'y ° law that this docsmnst and an attachments were TELEPHONE DATE <br />pmpomd ender my dtrsetlon or wperelston In anoedonre with a system deigned <br />to alum that q-Aned pe.,onnel propedy gathn and ee.lu.tr the Inror,nellon <br />submitted <br />based on my Inquiry of the person or <br />ersona who mana <br />e IM s <br />sterm <br />. <br />p <br />g <br />y <br />or those pera°na directly responsible for gathering the Information, the Inrormallon <br />submitted I& to the bet of my knowledge and belief. tree, atconte. and complete. <br />if <br />SIGNATURE OF MINCIPAL EXECUTIVE ' •: <br /> I am awom that there are sign <br />icant pemitfes for sub-liting foist Infamnallow, <br />TYPED OR PRINTED Indudlrsg the podblllty or fine and Imprisonment for knowing violations. OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference ed strachments hors/ <br />P:_i P EV'r:64T IS ?F ('L.r?IiYI APPRfJ'Jt'.i I?Y i.)r?CL): <br />EPA Form 3320-1 (Rev 3199) Previous editions may be used This is a 4-part form. PAGE OF