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PERMITTEE NAME/ADDRESS,/mlud.• Fwilin ,Vame'llann.,,, rt oifl•,r•mr <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 Approve <br />OMB No 204 <br />NOTE: Read Instructions before completing this forn <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAM <br />OF <br /> TY <br />EX <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT _ - :. . <br /> REQUIREMENT - 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 cerrty under penalty -1 law that this dtxamcnt and all atr.whment- were TELEPHONE DATE <br /> prcrared under m} direction or supenaston in accurdatace with:,,%,tem designed <br /> u, -ure that qualified petu+nncl properh gather and e,aluaic the mlitrmauun -: '-- <br /> submitted. Erased on my inqurn of the pcmm or pcrs ns who manage the sy'lem. <br /> N responsible for gathering the information the information <br />or those persons diectl <br /> l <br />d b <br />f <br />d <br />l <br />t <br />l <br />* l <br />_ , Iruc. accwate an <br />submihed is. k+ the best of my know <br />edge an <br />e <br />ie <br />comp <br />e <br />e <br />k SIGNATURE OF PRINCIPAL EXECUTIVE _ - J <br /> e information. <br />I am aware that there are significant penalties for submitting la <br />l <br />f <br />k OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MO <br />TYPED OR PRINTED rnwrng +u+ <br />auom <br />including the po ::hr!u .,t lint :arid mtpnsnnnr•nt <br />or CODE <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference an atracnments nere) <br />rLr- <br />RE <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. This is a 4-Dart 1om1.