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PERMITTEE NAME/ADDRESS rlndude Faci/in A'amdl-ation if pifferenq <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />LEACH, SR <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPOES) <br />DISCHARGE MONITORING REPORT (D R) <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 /> <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY SAMPLE <br /> <br />E OF <br />TYPE <br /> X ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />MEAS <br />R <br />M <br /> U <br />E <br />ENT <br /> PERMIT f ; E r _ <br /> REQUIREMENT 3Qi? t-', ,) x -tii •i, <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REr 7 T7 <br /> REQUIREMENT 1?' n I I_ N X <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT 't .. _, :. <br /> REQUIREMENT <br /> SAMPLE 1 <br /> MEASUREMENT <br /> <br /> <br />PERMIT <br />f <br />. ;r s 2 -': <br />:f ?? tt 3t Y 17 ROR <br />F <br />1? - <br /> REQUIREMENT ;}r; I L.?? Mx n <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 I crrur) under p•nadry of law that this dnvmeot and all attaches a were <br />d <br />d <br />di <br />e TELEPHONE DATE <br /> prepare <br />rection or sup <br />un <br />er np <br />rsision in acrordame with a yimem drsigned - c ? <br />- In a..ure that t ualifuA onnel ro rls <br />! dx ? p pr anther and esuhmle the information ?? - <br />y?-. - -- --- - <br />r'" whmiurd. 11-d on m? inyuin or the pet'-nor pe-ns who manage the -win. <br /> <br />ur thine persons directh mpmsihlr for gathering the informatiom, the information C <br /> %ahmitt •d is. to the M•a of m? knowledgr and heliel, true. acrunne, and complete. -- <br />- - I am aware that there aer si <br />nificant <br />enalties fu <br />bmittin <br />lx i <br />s <br />r <br />f <br />atio SIGNATURE OF PRINCIPAL EXECUTIVE <br />TYPED OR PRINTED g <br />p <br />r <br />u <br />g <br />a <br />n <br />orm <br />n. <br />in lading the 1-ibilit% of fine and impri4mment for km)wing tiolations. OFFICER OR AUTHORIZED AGENT A <br /> <br />REA NUMBER <br />CODE <br /> <br />YEAR <br /> <br />MO <br /> <br />DAY <br />L.VMMCt`I I J AIYLJ CArl-ANA I IVN Or AIV T v <br />neie) <br />EPA Form 3320-1 (Rev. 3/%) Previous editions may be used. .. -This?iy? 4-Paft frimi.