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PERMITTEE NAMEIADDRESS Includr Fact ri %arnol nnut„n :j Ndf, crab <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br /> <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 />HG:iTT <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. <br />EX FREOUENCY OF SAMPLE <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT s = -, <br /> REQUIREMENT f a <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 />REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER 1 m•tifv under penults ollaw that 11P d04vment and all attuchmrnts were <br />si <br />di <br />ti <br />with <br />st <br />d <br />l <br />d <br />i <br />i <br />i <br />d <br />d r TELEPHONE DATE <br /> <br />• <br />- gne <br />er tat <br />nn wr super <br />s <br />un <br />n accur <br />ame <br />a g <br />em <br />e <br />preparn <br />un <br />rec <br />In am ore that yu.ddied pe-nnel prnprriv under and evaluate die mf rnwtion ---i=---- -;?-- " f <br />- ?- <br />-' •uh.d d. Hawed un nn inyuin of the person ur per nas wha manage the -trm, <br />- or thn+e penom direclb, respmsibte far gathering thr information, the information [7` t <br />-, vuhmitted n. Iw the twwl d mi knuwledgc and halter, true, accurate. and complete, <br />l <br />k <br />i SIGNATURE OF PRINCIPAL EXECUTIVE ) <br />6 <br /> <br />TYPED OR PRINTED I am awre that torn are signifiant pena <br />ties far submitting la <br />nformation, <br />e <br />including the p-ibilit? otfine and imprisonment for knowing viula6nnc, <br />OFFICER OR AUTHORIZED AGENT EA <br />E NUMBER <br />m. <br />YEAR <br />MO <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />THIS tl1,I i FA! - t ' F N'?r, <br />i_Y S <br />PAGE OF <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used 11116 is 3 4-Part fonii.