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PERMrTTEE NAME/ADDRESS (7-,r+s«'wg)W..WL«arl.ndn(01."n+l <br />NAME <br />ADDRESS <br />I:F CL) <br />FACILITY lily <br />LOCATION cc <br />--L-Ly ar l;iii 1 ;, r or 0 <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM JNPDESJ <br />DISCHARGE MONITORING REPORT (DMRJ <br />PERMIT NUMBER k7l.-.0E NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved. <br />OMB No 204043004 <br />NOTE: Read kKtruc tom before completing this form. <br /> <br />PARAMETER <br />QUANTITY OR LOADING <br />QUALITY OR CONCENTRATION NO <br /> <br />NO. <br /> <br />EX <br />PRCOUENCr <br /> <br />OF <br /> <br />SAMPLE <br /> <br />TYPE <br /> ANALrsls <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/T1TLE PRINCIPAL EXECUTIVE OFFICER 1 mrioly wnid? penalty m aw that this dotnmeM and all .luehmenu..e.t TELEPHONE DATE <br />prepared tinder my dlrerllon or.rprr+ilfon In accordance wilh • System deAgned <br />to smart that qualified personnel property g.thrr and er.lu.lr IM Inforn.llon <br />submllled. Bead on my Inquiry of the person or persorn who manage the System, <br />or thoar prrna s directly responsible for gathering the Inform.llnn, the Information <br />- - submllled Is, to the best or my knowledge and better, true, occuratr, and complete. <br />SIONATURE OF PRINCIPAL EXECUTIVE <br /> I .m aware that there art s1gNBont penaltW for.rhmt.ting to]" Informatlon, AREA <br />TYPED OR PRINTED lnc+ndlng the poelbllllr of nnr and Imprf.onment for knowing rlelatlorm OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIULA I IUN5 prnerence am eReCnments neref <br />EPA Form 3320-1 (Rev 3199) Previous editions may be used This is a 4-pan form.