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PERMITTEE NAMEIADDRESS 4n,ludr Fa,dai %n,it, i.. w mt i/ biff renv <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMA) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MID 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 NO. FREOUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />ll :(fir. <br /> SAMPLE <br />P <br /> MEASUREMENT ., <br /> <br /> PERMIT <br /> REQUIREMENT v IV'AL <br /> SAMPLE _ <br /> MEASUREMENT <br /> PERMIT } ... <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />1 <br /> <br />f r ; <br /> <br />1 <br /> <br />! <br />? <br />. MEASUREMENT <br />. <br />- <br /> PERMIT - s <br /> REQUIREMENT JF` - <br /> SAMPLE - I _ <br /> MEASUREMENT <br /> <br />PERMIT 77 <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT -,. - - - <br /> REQUIREMENT - <br />NAMENITLE PRINCIPAL EXECUTIVE OFFICER I certif. under penaltt of law that this document and all attachment%were <br />ith <br />y <br />d <br />d <br />di <br />i <br />i <br />i <br />i <br />d <br />d <br />i <br />d TELEPHONE DATE <br />,\ I er mi <br />on or supers <br />n accor <br />ance w <br />gne <br />prepare <br />un <br />rect <br />s <br />on <br />a s <br />stem <br />es <br />to assure that qualified Personnel prnrierl, gather and csaloale the inrormation <br />mmotts who mana <br />ste n <br />suhmitled <br />Based on m <br />in <br />uire of the <br />rnon or <br />e the % i <br />-'- - <br />? <br /> . <br />? <br />q <br />p <br />i <br />g <br />% <br />. , <br />?? <br /> or those pen.m% directh responsible for gathering the information. the information -. - f <br /> h <br />itl <br />th <br />b <br />f <br />* k <br />wl <br />li <br />r <br />tr <br />o <br />and c <br />lete <br />d i <br />t <br />t <br />d <br />d h <br />l <br />-.t. <br />' - m <br />e <br />o <br />es <br />o <br />m <br />no <br />ge an <br />, <br />ur. acc <br />ru <br />e, <br />omp <br />. <br />w <br />s, <br />e <br />e <br />e <br />e <br />h <br />it <br />f <br />l <br />f <br />ti <br />I <br />h <br />th <br />i <br />if <br />lti <br />f <br />i <br />i <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />- <br /> am aware t <br />reant prua <br />on. <br />at <br />ere are s <br />un <br />es <br />or su <br />m <br />t <br />ng <br />a <br />se <br />n <br />orma OFFICER OR AUTHORIZED AGENT REA <br />TYPED OR PRINTED <br />I including thc• p.wsibilit} of fine and imprisonment for knowing sinlations. A <br />NUMBER <br />DE YEAR MO DAY <br />GUMMt:NIb ANU LAI LANAIIUF4 Vr m"T YIVLAI IUNa (rfelefellGe dil dfldGlUlleR15 flerel <br />r: SLIL i S ON THIS IDUTFALL. I F- NOT, <br />'',TISFICALL'V SIGNIF RIFF BrWN Tk-;" <br />EPA Form 3320-1 (Rev. 3,'99) Previous editions may be used. This is a 4-pact form.