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PERMITTEE NAME/ADDRESS Rnelrrdr Fatrhn• Nrxne•1Lrxurron rjDijjrrrnn <br />NAME <br />A L)R 5 <br />FAG.;, IT'i <br />LOCATION <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) Jqu Form Approved. <br />DISCHARGE MONITORING REPORT (DMR) OMB No. 2040.0004 <br />PERMIT NUMBER DISCHARGE NUMBER P El LAN <br />MONITORING PERIOD ` <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> EX OF TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />r <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 />NAMFJITLE PRINCIPAL EXECUTIVE OFFICER I cemfy under prtwlty of law that this document and .ill .machments were <br />-- prepared under my direction or copervimon in accordance with it system desi <br />ned TELEPHONE DATE <br />" <br />g <br />to assure that qualified peaonnd properly gather and evaluate the information <br />submitted. Based on my inquiry of the person or lwi-wns who manage the svstcm, - <br />_ or those prawns directly resr.,nmble I'm gathering the information, the mformauon <br />suhmitAd is. to the hest of my Anowlcdkc and belief. true, acrurntr, and complete. SIGNATURE OF PRINCIPAL EXECUTIVE - - <br />1 -iuare that there are signifir,nn for submitting fal-+c uttwrmation <br />. <br />TYPED OH PRINTED ;:j':1e the la,ssibihty of nm ,n.: mpn,onmcm for 6nowmc violations. <br />?asu. ? <br />LIM 1 w will + lsr A- - OFFICER OR AUTHORIZED AGENT AREA <br />CODE NUMBER <br />YEAR <br />MO <br />A <br />?HR RECD'. EVENT - SEE T. A. 1, PG 3. FOR REQt%IPEMI <br />SAMPLING INST"r,:UC IGNS - I C;. P:; 1+?. <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. „?9t, This is a 4,Mrt form.