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PERMITTEE NAMErADDRESS rlnrhrdcFailip AttmeLrc'attrmi(DiQ'crrat) <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 />NOTE: Read Instructions before completinq this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SA <br /> OF <br />EX <br />T <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />t: MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />r 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 certify under I -natty of lass that this dlKument and all attachnTcnt, were <br /> <br />r <br />ared under m <br />direction or <br />ry <br />rd <br />uh <br />t <br />ed <br />d <br />TELEPHONE <br />DATE <br /> p <br />ep <br />} <br />supe <br />tst:m in acco <br />ance w <br />esign <br />a sys <br />em <br /> to assure that qualified personnel properly gather and evaluate the information <br />submitted Ra <br />d <br />n m <br />i <br />ir <br />f th <br />s <br />y <br />s <br />h <br />th <br />t <br />-? <br /> se <br />o <br />y <br />nqu <br />y o <br />e per <br />on or per <br />ons w <br />+, manage <br />e s <br />s <br />em. YE <br /> or those persons directly responsible for gathering the information. the infra,nation - <br />r su I Yl is. to the hhst of my knms ledoe and hcfcf. In+r accurate and oln low t <br />I e!n r.+.rr ib.u ihrrc r ?:cucic s?v t+r:?: lu;s r?:?r ?.:pni?ti PiY false ulf+r <br />TYPED OR PRINTED m hid.i a rf,c vo :.ih:?i;..?t Fui? .mr rnl ai o-.r. Mien' ;or ::a?,+;np ctolauo <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />320"1 (Rev. 3199) Previous editions may be us <br />YPE <br />OFFICER OR AUTHORIZED AGENT AREA ' __ NUMBER YEAR MO DAY <br />COME- ?- - - - - _ <br />This IS.a 4-Part fomi. PAGE OF