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PEHMITTEE NAMEfADDRESS,lnr!nd. <br />NAME <br />I? ADDRESS ?ERADI <br />FG.CILIT;' <br />LOCATION <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPOES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br /> <br />ante. n-_? I <br /> <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO• FREQUENCY SAMPLE <br /> OF <br />T <br />PE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ? ANALYSIS Y <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT r <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />F MEASUREMENT <br />I <br /> PERMIT _ i r'0 n: L; 1 <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />L . C , F, "'•, MEASUREMENT <br /> PERMIT <br />t?... REQUIREMENT :, - <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT _. ,'Ft'.?tZ r f1; <br /> REQUIREMENT - <br /> SAMPLE <br />I MEASUREMENT <br /> PERMIT F ?= c' -`I i T P. <br /> REQUIREMENT t : it <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certify under penalty of law that this documumt and all attachn-ints were TELEPHONE DATE <br />,- _ prepared andcr my direction or supervision in accordance "jib a system designed <br /> <br />• to assure that qualified personnel properly gather and esaluate the mfortnairon -- <br /> submitted. Rased on my inquire of the person or persons wlm manage the system. - - 'v- <br />.- or those persons directly responsible for gathering the information. the information <br /> submitted is. to the best of my knowledge and belief. true, accuratc. and comploc' <br />h <br />i <br />h <br />ifi SIGNATURE OF PRINCIPAL EXECUTIVE <br /> I am aware t <br />ere arc. <br />gn <br />in t <br />cant penalties for submuting tali information. <br /> <br />TYPED OR PRINTED <br />including the possibility of tine and Imprisonment tbt kno•.wng ciolatioms. OFFICER OR AUTHORIZED AGENT AREA <br />CODE NUMBER <br />YEAR <br />MO <br />DAY <br />rr1UUr-NITC Akin CVD1 ALIATIn AI /lC AKIV t/Inl ATI/1AIC /O..f,.......,.. -it _-. <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. t?L, This i3 a-4-part form.