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PERMITTEE NAME/ADDRESS,lru!rrsit Frxi/in•,Nume'L«mran ifOryi•rr•rt!r 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 FROM YEAR MO DAY TO YEAR MO DAY <br />NOTE: Read Instructions before <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. IFREOUEN <br /> <br />>< EX OF <br /> <br />- AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ANALYSIS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT t <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 r" ..•,tT `-' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT _ <br /> REQUIREMENT <br />NAMEITITLE PRINCIPAL EXECUTIVE OFFICER -•-rd} under pen:Jtc of law that thi% dcwument and .ru :rn.t.hment. were <br /> <br />- <br />TELEPHONE <br />DATE <br />- •= <br />,pared under m} due ?rion or surxmvision to accordan'c wuh a system designed - i <br /> to assure that yuahh •d personnel properh w tth •r and ccu!uatc the mbrmatiun <br />? <br />" <br />- submmed Based (,it nts? myun- of the jicrs, n or persons wbu manage the isstem• .?.%: <br />- <br />_ ? <br />- or thox persow dtrect!y responsvb!c for gathcnng the mfomtenon• the mtomtmrcm <br /> suhnnawd is t th • hest of my know ledge and hchcf• tntc. A-unne, and cons lete <br />p <br />I <br />w <br />th <br />t th <br />i <br />l <br />i <br />SIGNATURE OF PRINCIPAL EXECUTIVE /-• : (- ! .. ;- ' -? - <br /> am a <br />are <br />a <br />ere are signif <br />cant pena <br />ties for subm <br />tting lake information, .,.•?..? ---- <br />NUMBER 'YEARI MO I DAY <br />Form Approved. <br />OMB No. 2040.000.1 <br />this form. <br />CY SAMPLE <br />TYPE <br />EPA Form 3320.1 (Rev. 3199) Previous editions may be used. TWS is 8 4-part fomi.