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PERMITTEE NAME/ADDRESS 4neludr• Farilrn Name 1-wn,+ ! Itiltrnrr NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />NAME DISCHARGE MONITORING REPORT (DMR) <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 SAMPLE <br /> <br />E OF <br />TYPE <br /> X ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />MEASUREM <br />T <br />Ir' <br />' 2A <br />x <br />11? <br />J r,1 <br /> EN • <br /> PERMIT <br /> REQUIREMENT ` ? <br /> SAMPLE <br />MEASUR <br />? <br />r WE, <br /> EMENT - <br /> PERMIT - <br /> REQUIREMENT tCJfu i <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />MEASUREM <br /> ENT <br /> PERMIT <br /> REQUIREMENT ?ir <br /> SAMPLE <br /> <br />MEASUREMENT <br />Z1 <br />? <br /> <br />?Qr <br /> PERMIT _ <br /> REQUIREMENT <br /> SAMPLE ; <br /> MEASUREMENT 0, Q3`-= `Z 043 i f.tS ? <br /> PERMIT * .. r?- i r,t• <br /> REQUIREMENT <br /> SAMPLE <br />I <br />5 <br /> MEASUREMENT -4 <br />uA(_ <br />- <br /> PERMIT I <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I eertif. under Penalty of ta,, that the, d-men-ot and all ana.hmenN Derr <br />r <br />arrd und <br />r <br />- di <br />- <br />d <br />w TELEPHONE DATE <br /> P <br />cp <br />e <br />re. t ar ulw nt <br />,,o to accor <br />m <br />ance e <br />, a y t m designed _ <br />_ 1 assure that tiualirwd pi -on el I r pert. gather and -luate the inf nnation <br />9 <br /> sohmilled. <br />--don my inyutn cf the peraat ur W-m who manage the -stem. <br />-` or Iho.e pens dirmili t ? Iwmstbh for gathering the information. the lnformatiun = Y - - , <br />- - - suhnt itbd n, In the heel •f m. knowledge and hrlieL tnn•, accuntr. and complete. - .' -t ?. ?? - ?? ?J <br /> I .mi .u.arc that there an ipuirtcunt penaltie, for suhmitung false information SIGNATURE OF PRINCIPAL EXECUTIVE `- <br />TYPED OR PRINTED . <br />Including the im-ibilit-1 One and imprisonmrnt for knowing violations. OFFICER OR AUTHORIZED AGENT AREA NUMBER <br />CODE YEAR MO DAY <br />ANU hAPLANA 1 IUN OF ANY VIOLA I IUNS (Hererence an atrachments here) <br /> <br />EPA Form 3320-1 (Rev 3/99) Previous editions may be used. C, This it a 4-part farm.