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PERMMEE NAME/ADDRESS /n; hide Faciliq- Mime 1"ation y Diffemntf <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <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 App <br />OMB No. <br />NOTE: Read Instructions before completing this form <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SA <br /> EX OF <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 <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 />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER mify under i cmdts of law that this document and all ettaehments were TELEPHONE DATE <br /> p rcpared under my dnecuun Of Snper%Man in aectirdance with a system designed <br />_ <br />:r - '.• i' - :,, a-ure that quahtictl peronnel properly gather and c%aluate the tntormanon <br />.,uhmitted Rased on my inyutry of the person or pennons "ht- manage the syntcm. <br /> or th-c pcrsam; dncctly responsihlc f rr gathering the ininmtauon• the tn(,rmanun <br />_ <br />` ubmttied is, to thr br.t .•f in, knowledge and belief. true. accurate, and complete <br />th <br />ii <br />I <br />l <br />f <br />l SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />TYPED OR PRINTED am ow arc <br />: r: •.. :- 111 i rna <br />ee <br />ucs t +r w ii-i <br />s <br />sg information. <br />mdudmg the pr.>r :m. v it r;d .inpn;onment for r k knowng violations. violations. <br />OFFICER OR AUTHORIZED AGENT AREA CODE NUMBER YEAR MO <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />R Qt <br />MPLE <br />TYPE <br />aY l <br />EPA Form 3320-1 (Rev. 3/99) Previous eddions may be used. This i.A a 4-part fonn. PAGE OF