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PERIiMITTEE NAME/ADDRESSpaerirfr+Ury N?a!L«rto+l/D?fr..U <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />NATIONAL POLLUTANT DISCHAROE ELIMINATION SYSTUA frNPDES? <br />DISCHARGE MONITORING REPORT (DMR? <br />PERMIT NUMBER 04SCHAAGE NUMBER <br />MONITORING PERIOD <br />YEAR MO' DAY YEAR MO DAY <br />FROM TO <br />Form Approved <br />OMB No 2040-0004 <br /> <br />NOTE: Reed kietrucdona before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ, <br /> <br />EX fREOUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <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 t <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />AMEMnE PRINCIPAL EXECUTIVE OFFICER ' n""y w r Pen"y - that thk doeveter" and .11 .tt.rhm nts rare <br />TELEPHONE <br />DATE <br />N <br />prepared wader ,wy dtreef oo or wper.t.ion Ie ae< .ere fIh a system designed <br />to amn that quanfled personnel property Liner and e..htair the inrorn 00on <br />submitted. Bowed on ?y inquiry of the person a prrsorn +ho manage the srsterm <br /> <br />at those per,ere dirsrlly resporMbk ror ptherirrt the Info iloe, the lnro-ethrn <br />,. % wt m"I ed b, to the Lest of ink kt a kdte and beef. Irv., ae'[vnie, and tompkte. <br />810NATURE OF PRINCIPAL EXECUTIVE <br />ln <br />t <br />t <br />i <br />t <br />- <br /> I am ..are that there are s <br />tn <br />ca <br />prnalth. for akm <br />ttint fa <br />: Wbi <br />n itloe, A A <br />TYPED OR PRINTED Inrfudlnt the poodLlUt1 of flee and hnpAsonmrni for kno lnt Hoiattores OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reforenc• aMaffachmatrilshanl vF-?? U lJtaII=:L?. <br />EPA Form 3320-1 (Rev 3t99) Previous editions may be used This is a 4-part form. PAGE OF