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PERMITTEE NAMF/ADORESS(7.d.6F«+hryN..?Lor.11al/D(ff. t) <br />NAME <br />ADORES S <br />FACILITY _.,._ <br />LOCATION :-'{ >= Fi' (? C? I G <br />SANDER Y OF OP n <br />NATIONAL POLLUTANT 04SCHARGE ELIMINATION SYSTEM //NPOESI <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY Y R MO DAY <br />FROM TO <br />Form Approved <br />M I j , OMB No 2040-0004 <br />TO GOOD <br />NOTE: Read Irntructlone before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREOUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br />r r LLIL!,?_i ;F ?`Al t-J REQUTAEMENT Ufa ;'r f^r :'. <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 -M.1y . r penalty o (law that 1MS document and an attarhmano wen TELEPHONE <br />erslalen In -dam,, with • system designed <br />r m <br />cllon or m <br />ared und <br />dlr DATE <br />y <br />p <br />prep <br />e <br />e <br />to enure that quallfled personnel properly gather and t•aluate The InGRmatbn <br />ersons who manage the s <br />fn <br />ul <br />or the <br />erron M <br />/lem <br />b <br />11Ted <br />Bas <br />d on m <br />/j <br />" <br />y <br />q <br />P <br />p <br />y <br />. <br />n1 <br />e <br />q <br />su <br />. <br />or those person directly reepomlble for gathering the Informalloe, the Information <br /> <br />. <br />r <br />_ <br />slrbmlTled ls, to the best of my n knowled and belief. Ime, a rare. and complete. <br />IGNATURE OF PRINCWAL EXE <br /> 1 am aware that then art ygnifitant penalties for submltdng bate Information, S AREA <br />TYPED OR PRINTED Inrluding the p nailbility of fine and lmprhoament for kno.ing IWaWm OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />= T IS ! ti <br />COMMENTS AND EXPLANATION VF nnr vtvLPkIIVna InererenCe NR .tv.wtrn.nea (, <br />EVf4 <br />THIS r-T T laF ';?I. IV l_ l . <br />EPA Form 3320-1 (Rev. 3/89) Previous editions may be used is .? 4-part Form PACE Of