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PERMITTEE NAMEiADDRESS awludeFau"rli!) Ram, --:,m orjDA1enwt) <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 />AR MO DAY <br />YEAR MO MTOF- YE <br />FROM NOTE: Read Ingtruchnns hetnre r"mmnlatina this form. <br /> <br /> <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT nZa <br />F c 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 /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAMEITITLE PRINCIPAL EXECUTIVE OFFICER I ccrnfy under Petwlty of luw that this document and All attachments were <br />1 TELEPHONE DATE <br />_ prcpvnt under my Jirecnon ar ,uPen tvun m ;wcordancc with a system designed <br /> <br />?- to assure that qualified pcnonnel Properly gather and evaluate the inforntatim <br />;<=P <br />. subminct. Based on my inquiry of the Person or pcruons who manage the }stem. . <br /> or those Persons dimt]N responsible for gathering the infiortnauon. the infortnation <br />?-? 1- submitted is. to the hest of my knowledge and bchel, true, accurate" and complete. <br /> <br />th <br />h <br />i <br />th <br />fi <br />l <br />ul <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED OR PRINTED am aware <br />at <br />ere are signi <br />cant pena <br />tw, r rt "; <br />nuttmg t <br />le m <br />roe. <br />i <br />n <br />l <br />di <br />th <br />f f <br />d <br />+ <br />b <br />lit <br />k <br />h <br />l OFFICER OR AUTHORIZED AGENT AREA <br /> imes <br />rrnpmpr <br />ine d en <br />sonrncnt t r <br />i <br />u <br />ng <br />e p <br />sst <br />r <br />y o <br />auons <br />c <br />nnwmg v <br />+ CODE NUMBER YEAR MO DAY <br />on naaaa.nnrcnw act c/ <br />.jN <br />;r i 3320-1 (Rev. 3,'99) Previous editions may be used. This 15 a 4 -part form.