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PERMITTEE NAME/ADDRESS (include Pacdin Ati nellteanan if Diffrrenri <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-tti !» <br />(UDR JC) <br />F - FINAL ROUTI <br />?UR17ACE RUNOFF TO TROUT :RLEIf. <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREOUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE 1 <br /> MEASUREMENT <br /> PERMIT in H U <br /> REQUIREMENT <br /> SAMPLE , <br /> MEASUREMENT r I " <br /> PERMIT ? r# s X #### tt 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 <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />7 REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER 1 .,nip tinder pvnalq or law that this dtwument and all attachments wrre <br />i <br />i <br />h <br />d <br />d <br />di <br />e <br />ti <br />i <br />i <br />d <br />d <br />i <br />d ?- - / TELEPHONE DATE <br /> prepare <br />er my <br />a c?%iem <br />gne <br />un <br />r <br />c <br />on or sup- <br />c <br />un <br />n uecer <br />anee w <br />t <br />es - <br />t <br /> <br />` C , <br />% 1t <br />' ?•C- V to assure that qualified peramnel proprrh gather and rsaluale the information ?_ <br />- suhmitlyd. Rased on mt mquin or the person or Pervms who manage the stslern, -?_. - <br /> nr lhtw.e p-ons directly rusponsihfe for gathering the information, the inrormnlion - - <br /> .uhmilt d i., ..he heel of m? knowledge and belief. true, accurvtr, and complete. <br /> <br />I <br />ir <br />t <br />lti <br />itti <br />l <br />i <br />th <br />ih <br />i <br />f <br />b <br />f <br />i <br />f SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED OR PRINTED an( aware <br />ormat <br />on. <br />at <br />rrt arc s <br />gn <br />"n <br />pena <br />es <br />or su <br />m <br />ng <br />a <br />se <br />n <br />mcloding the possihilil% of fine and imprisonment for knowing tiohuions. <br />OFFICER OR AUTHORIZED AGENT AREA <br />CODE NUMBER <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLA I IUNS (hlererence all arracnmenrs nere/ <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. 00076 .-'Phis I' 3 4-pact foml. <br />3