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PERMITTEE NAME/ADDRESS 4nrludr Fardar Name:] o,eafiiat if Differrvu <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 />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 <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 /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I rertift under Iw•nal[y of law that this darument and all attachments were TELEPHONE DATE <br /> prepared under un dirlllion or -per.i.iun in accordance with a system dtyiRned <br /> to assure that qualinsd pers<mnrl properly Rather amt esaluale the inturtnalkm <br /> submitted. aasrd ton my inquire of the perwm or irerams who mange the system. <br /> or lhosr petwns directh rrsrwmsible for gathering the information, the informad"n <br /> submitted Lc. to the hest of nit knowledge and Ix-lit-f. tnn•, accurate. and cenoplrte. SIGNATURE OF PRINCIPAL EXECUTIVE <br /> I am aware that there arc siRniftcani penallie fur submitting falw inrnrmalium <br />ment for km-in <br />siolutions <br />ihilit <br />nd i <br />iso <br />h <br />r f OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br />TYPED OR PRINTED . <br />g <br />y o <br />ine a <br />mpr <br />n <br />including t <br />e Im- DE <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Rererence a?? arracnmenrs nere) <br />EPA Form 3320-1 (Rev. 3199) Previous editions may t>e used This is a 4-part form.