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PERMITTEE NAME/ADDRESS flnclade E'aciNy Aamirl ocarion if Diffe"nll NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES) <br />NAME DISCHARGE MONITORING REPORT (D R) <br />ADDRESS <br />PERMIT NUMBER DISCHARGE NUMBER <br />FACILITY MONITORING PERIOD <br />LOCATION YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved. <br />OMB No. 2040-0004 <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT Y O Lr ;?, <br /> REQUIREMENT <br /> SAMPLE <br />' <br /> MEASUREMENT f <br /> PERMIT - <br /> REQUIREMENT i ; <br /> SAMPLE <br />l jj <br />- <br />l <br />? <br /> MEASUREMENT -- < G J ' - <br />' <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />M <br />RE <br />E <br /> EASU <br />M <br />NT <br /> PERMIT i_F'rlTC rr . l .. - <br /> REQUIREMENT <br /> SAMPLE <br />( 2 <br /> MEASUREMENT . <br /> PERMIT *` •? # , ;. ;i. t ii: R <br /> REQUIREMENT '- <br /> SAMPLE - <br /> MEASUREMENT <br /> PERMIT -. ' 77 <br /> REQUIREMENT <br /> SAMPLE <br />X11 -'`• AL <br /> MEASUREMENT <br /> PERMIT ,' :? • .:. , .. .. -= ?-"' - <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER l cerfify under penalty of law that fhi% document and all auachmrnts wrn <br />c <br />t <br />i <br />d <br />i <br />i <br />i <br />d <br />i <br />h <br />d <br />1 TELEPHONE DATE <br /> n accor <br />unce w <br />gn,, <br />prepared under my dire. mat or supcn <br />s <br />on <br />t <br />a s <br />s <br />rm <br />n , <br /> lu assure that yualifled {w-ainel property "ther and evaluate the {nf annaliun <br />t <br />_.F <br />f <br /> a, or persons who munugr the system. <br />wbmitled. Rawd on my wyuir, of thr pr • <br />_ (it th.nt person, dirtrU3 n-{ible for galta•ring the information. the inforlnalion <br />a <br />- - - - -, <br />' <br />• - wbmillm is, to the htxt of my knowledge and belief. trot, accurate, and complete. <br />l <br />i <br />I <br />h <br />l <br />I <br />f{ <br />h <br />f <br />it <br />t <br />f <br />i <br />f <br />t <br />SIGNATURE OF PRINCIPAL EXECUTIVE -' : f - •-• `' i ? i._' 1 L._ \ <br />-? <br />TYPED OR PRINTED am NN are I <br />lrs <br />rm <br />wm. <br />a <br />I <br />Mre 1r.' igm <br />19111 {xrla <br />ar.u <br />t <br />uR <br />o <br />u <br />n <br />nrma <br />including g the wws ihilits ..f fine and imp' nwnmenl for knowing iobtli,ms. OFFICER OR AUTHORIZED AGENT AREA NUMBER <br />CODE YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. This'is` a 4-part fornl.