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f PERMITTEE NAME'ADDRESS,i,: o,.ic 2 - <br />rnrr <br />NAME <br />NAME <br />ADDRESS <br />:Ir <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 />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved. <br />OMB No. 2040-0004 <br />NOTF Rears Instrtfrtinns hPfnrP cmmnlPtina this farm. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT _ r: ils <br />y }_ REQUIREMENT - <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT G <br />I`if3N fl f <br /> SAMPLE = _ - <br /> MEASUREMENT <br /> PERMIT t. ?. - <br />S;• REQUIREMENT +i7,iTF1 <br /> SAMPLE - - <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />1 t ,l r rNl, Vr?i f REQUIREMENT ?.; <br />G' .. 7 <br /> SAMPLE <br />,. TME'.NT P:- MEASUREMENT <br />J PERMIT <br />?. F._:. , REQUIREMENT - y . <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT T €iEF;_ h, - <br /> REQUIREMENT P. V`!= L71k ? t <br />NAMErnTLE PRINCIPAL EXECUTIVE OFFICER I ccnify under penalty of Iae that this document and all tntachments were TELEPHONE DATE <br /> prepared under m} dirrcoon or supersr.ion in accordance with a ssstcm designed <br /> <br />- to assure that quahtied personnel properly gather and evaluate the mtor"mium _ - -' -- <br />'.._. <br /> submitted- Based on my inquiry of the person or perums who m.inaee the ,ygcm. , -• _.? •-?j? T? <br />' <br /> or those persons directly res;xir ble for gathering the information. the information CI ' v?Y7 <br />;? -_ <br /> suhtnitted is. to the hest of m% knox4edgc and belief, true. accurate. and coinplctc <br />: <br />i <br />t th <br />th <br />i <br />i <br />l <br />? <br />f <br />i <br />b <br />l <br />f SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED CFO PRINTED n <br />,n ;vr <br />a <br />ere are sign <br />f <br />cant peni <br />it <br />s f <br />ir su <br />se in <br />mitting <br />a <br />onnuu,m. <br />m <br />ii <br />• th <br />sib <br />hi <br />e <br />d i <br />f ti <br />i <br />t f <br />k <br />l <br />i <br />i OFFICER OR AUTHORIZED AGENT AREA <br /> , <br />, <br />e Ixn <br />% o <br />n <br />i <br />an <br />mpr <br />sonmen <br />or <br />reiwute t <br />o <br />at <br />ons CODE NUMBER YEAR MO DAY <br />.+vv.v?a.r?r.a r?iw v?r ari?r?. ivi• vi ?i? i •rvu?i iv?w tamer cna.c mr auaa.nnicnw nor c/ <br />•AP <br />!7 FC 1 R <br /> <br />T 1I` T _ f^ T G r <br /> <br />p?. -r? PF <br /> <br />-:'.t'Ttj •_=T.1 <br /> <br />: .7 .• <br /> <br />EPA Form 3320-1 (Rev. 3/99) Previous eddions may be used. This iS A.4,part fon-n. PAGE OF