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PEAWTTEE NAME/ADDRESS17no FardliryNamof Ntd.l/vfdb..r/ <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />NATIONAL POLLUTANT DISCHARGE EIIMINAT10M SYSTEM jIWDES1 <br />DISCHARGE MONITORING REPORT (DMRJ <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, <br /> <br />EX FREQUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT iT^,IJP'i <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT n4 <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br />REQUIREMENT <br />CIA <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />1 crnay under pen. ly o aw that Ihh dm tin rnl and ¦11 atlactrments wtnt <br />TELEPHONE <br />NAME/T1TlE PRINCIPAL EXECUTIVE OFFICER <br />DATE <br />Prepared under my direrthm or mpenhtion In ¦acordanre with a syslern designed <br />to Dune Ihal qualified personnel Property gather and tr alu¦It the Inforwullon <br />sabmltred. Bawd on my Inquiry of the person or perm" who manage t1w %"ter,,, <br />` <br />or those persons dimity responsible for gathering the Informatloa, the Informallon <br />i <br />- eubmtlred Is, to the best of my knowledge and beMf. Ire, amnrlr, and canpkle. <br />? I am wars that them are d <br />nlneant <br />rn.Me <br />f <br />•IGNATURE OF PRINCIPAL EXECUTIVE <br />ub <br />itti <br />W. I <br />rr <br />d <br />f i <br /> g <br />p <br />¦ <br />or s <br />m <br />ng <br />n <br />o <br />nai <br />n, <br />TYPED OR PRINTED Incimding the poarblllly M floe and Imprimnmrnt for k m tig rlolauona OFFICER OR AUTHORIZED AGENT CAE NUMBER YEAR MO I DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference RN attachments hare] <br /> <br /> <br /> <br />EPA Form 3320-1 (Rev 3199) Previous editions may be used This IS a 4-pert COrin. PAGE OF