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PERMITTEE NAME/ADDRESS dnelade FaciGfr.o'amebP ari„n l !,tprr.,u. <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />NATIONAL POLLUTANT OISCHARGE ELIMINATION SYSTEM (NPOES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />FROM YEAR MO DAY TO YEAR MO DAY <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, FREQUENCY SAMPLE <br /> OF <br />TYPE <br /> EX ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />MEASUREMENT <br />i? <br />L? ?•.` <br />Irk ?fT?-1 <br /> PERMIT <br /> REQUIREMENT h1rH k T h?! '. "ri <br /> SAMPLE <br />MEASUREMENT <br />-3 <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />MEASUREMENT <br />C <br />f <br />- rl?:`j <br />t` f?.113 <br /> PERMIT _ ., :. E o s F.- <br /> REQUIREMENT <br /> SAMPLE <br />MEASUREMENT <br />_ <br />`?.I <br />Jv <br />t, _j <br /> PERMIT F ._ r _ . i h. • , r :..._ <br /> REQUIREMENT <br /> SAMPLE <br />MEASUREMENT <br /> PERMIT <br /> REQUIREMENT :. V;.> 1 i F 71 'l r, .. <br /> SAMPLE <br />!? <br /> MEASUREMENT L. i ? I!•j ;j71 <br /> PERMIT <br />t .. <br />r; _ ? i -fir. <br /> REQUIREMENT <br /> SAMPLE <br /> <br />MEASUREMENT `J <br /> PERMIT <br />s f? <br /> REQUIREMENT is i3A I L. <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER I certif> under penalq of law that this document and all attachments carne <br />d <br />d <br />i I <br />t TELEPHONE DATE <br /> prepare <br />un <br />er im ir <br />ormo or l r is <br />mm in erorlance with a ei <br />1. a-u <br />designed <br />o <br />r <br />oeri <br />to mare e that <br />ualifird <br />rmmnn <br />rn <br />athe <br />and <br />s nlu <br />t <br />th <br />ti <br />i <br />f <br /> <br />} ` --?? r` •` t <br />n <br />f <br />o <br />y <br />p <br />e p <br />p <br />y g <br />r <br />r <br />a <br />n <br />orma <br />e <br />e <br />on <br />it <br />b <br />d <br />B <br />d _ <br /> su <br />m <br />te <br />. <br />au <br />net tm inr uin of the ,rrv,n or "ms who manage the warm. <br /> or th:we persons du.rtl.?responsible for gathering the information, the information <br /> cuhmilled n- to the best or ttn know ledge and belief, tnx, accurate, and complete. <br /> I am aware that there are significant prn.llics for wbmitting fain inbrt•rnatimr SIGNATURE OF PRINCIPAL EXECUTIVE -- <br />TYPED OR PRINTED . <br />im-luding the pnsibdit. of fine and impriwnmr•nl for knowing violations. OFFICER OR AUTHORIZED AGENT AREA NUMBER <br />CODE YEAR MO DAY <br />Anv ttnrut?nA I IUfv Ur AN <br />(Kererence an attacnments nere) <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. "? nis'is a 4-part form.