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PERMITTEE NAME/ADDRESS anelude Faiilirr %ame/b,c ton of Differnul <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <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 NQ, FREQUENCY SAMPLE <br /> <br />E OF <br />TYPE <br /> X ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT I J Z l < 1?'?E3 <br /> PERMIT REF <br />.. <br /> REQUIREMENT DA 1 L'7' "I X <br /> SAMPLE <br />MEASUREMENT <br /> <br /> PERMIT „-)_i?i"R T REPORT U <br /> REQUIREMENT !X <br /> SAMPLE <br />M <br />NT <br /> EASUREME <br /> PERMIT r- 1 <br /> REQUIREMENT itv'•il;r _ <br /> SAMPLE <br /> MEASUREMENT <br /> <br />PERMIT r_1 F? T <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, L <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I ,-1if, under Wind is of taw Ihul this d-ument and all a1t-henenls mere <br />a <br />el <br />de <br />dtrmi i <br />n <br />s <br />with <br />i <br />d <br />d <br />i <br />d % TELEPHONE DATE <br /> pnp <br />r <br />un <br />r nn <br />o <br />or vtprr <br />n <br />on m accor <br />ance <br />a s? stem <br />es <br />gne <br /> <br />\ to wwrr that yualt6ed rw-nnel properl% gather and esaluatr the Inforntntirm <br />- - ' <br />'-"- suhmiued Based on m. mquin, of the person or persons who manage the system. <br /> or those persons, dirrctla rrsfwmsthle for gathering the mformatum, the mrurnwtion <br /> submitted is. to the be,1 of tm knowledge and belit•L true, aarurwtr. and complete. <br />_ <br /> 1 am aware that then - iPmrw,mi penalties for submitting false mfonn <br />uim SIGNATURE OF PRINCIPAL EXECUTIVE <br />TYPED OR PRINTED . <br />. <br />including the µnsibilits .r flnr wad imprisomnrnl for knowing siolauons. OFFICER OR AUTHORIZED AGENT AREA NUMBER <br />CODE YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY <br />(Reference all attachments here) <br />EPA Form 3320-7 (Rev. 399) Previous editions may be used. Thisis a 4 -part fOC[Il.