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PERMITTEENAME;ADDRESSanrludeFreilirr.Vann"L arim;iifbijArr'nf) <br />NAME <br />ADDRESS ?" <br />FACILITY <br />LOCATION <br /> <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 />x <br />NOTE: Read Instructions before completing this form. <br /> NO FREQUENCY SAMPLE <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION . OF <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 />i . SAMPLE <br /> MEASUREMENT <br /> PERMIT - , <br />F'' t: REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />i <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certify under penalty t+f taw that tins drwument and all attachmems were TELEPHONE DATE <br /> prctntm J under my dirwwn or supemsion in accordance with it system designed <br />diehard A. 1'ur Oi i to assure that yuahtinl personnel pnrpcrts gather and eyaltute the information. <br /> <ubmms+d Based on my inquiryof the person or persons u.ho manage the system. <br />P <br />id <br />t <br />V I ersons dnrmik. responsible for gathering the intonnauon. the mt:+rmaiior. <br />or those )"(; <br />! -. 4? A, 09 (J <br />res <br />en <br />ce p i <br /> submitted is. to the hest of my knosslcsige and hdief, true. accurate. and nanplete <br />t <br />i <br />G <br />l <br />i <br />; SIGNATURE OF PRINCIPAL EXECUTIVE <br /> +rtoan,a'. <br />es for u <br />mittmg t <br />dsr <br />that there are stenificum pena <br />t <br />n <br />a"are <br />l <br />i <br />d i <br />f <br />k <br />I OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MO <br />DAY <br />TYPED OR PRINTED cl <br />t <br />anon, <br />ne an <br />rnpn,omnem <br />nowing rro <br />or <br />including the possnblrty o(t CODE <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />4 Forrc 3320 1 (l ev 3 ss) Previous editions may be used. This is a 4 -part form.