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PERMITTEE NAMF/ADDRESS (include Facility N'ame/lncation if thffertn1) <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES) <br />DISCHARGE MONITORING REPORT (D R) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />FROM YEAR MO DAY TO YEAR MO DAY <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. FREOUENCY SAMPLE <br /> <br />EX OF <br />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 r _,•. . <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 />1 <br />r <br /> REQUIREMENT <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER I certifi under penalty of In. that this d-umrnt and :dl attai'lo •nh -err <br />cr.i.ion in accordance -ith a -ten designed <br />re <br />ared under nt% direction or su TELEPHONE DATE <br /> p <br />p <br />p <br /> to assure that yuuliried perwnrnel proprrl's gather and r. ablate the information <br />submitted. Based on m? mquir. of the per-o- or persons -ho manage the ...tem <br /> . <br /> or thine fa-m% dirertbe rc ponsibir for gathering the information, the information <br /> submitted is, to the heft of me koo-Irrige and Wier. true, accurate, and complete. <br />enalties for submitting ralse information <br />I am .rare that there am significant <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />TYPED OR PRINTED P <br />. <br />including the fmtssihibio of fine and imprisonment for knoring .iolations. OFFICER OR AUTHORIZED AGENT AREA NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />EPA Form 3320.1 (Rev. 3/99) Previous eddions may be used. This i5 a 4-part ton-n.