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PERMITTEE NAME/ADDRESS eInel+u4• fik, lirl-Na"Ye'L-ation ijDifjr,rrut <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 /> <br />Form Approved. <br />OMB No. 2040-0004 <br />X <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SA <br /> EX OF <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br />' PERMIT <br /> <br />REQUIREMENT _ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT 71 777 <br /> REQUIREMENT 1 <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT - <br /> REQUIREMENT ;`•i TF ! <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT r - FTZI <br /> REQUIREMENT <br />NAME,TITLE PRINCIPAL EXECUTIVE OFFICER I .emty under lx-nalty of late that this dtRumma and al! attachments were TELEPHONE DATE <br /> prepare d under my direction or supertision in accordance with a system designed <br /> to assure that qualified personnel properly gather and valuate thr utfitrmat,on _ _?---- _ <br />' suhmitted Based an my inquiry of the person or prrw. n. who manage the ystem. <br /> or those p mirv%diaectfy respuisible for gathering the inbmna ion. the mfomLv,,, n [ -'•'"s'? it- I <br />% suhmined is. to the tics; . i nr. Aa„wledee :md hclicf true accurate. and complrte <br />am aware that th <br />r ar n <br />n i <br />u <br />h <br />lid <br />l SIGNATURE OF PRINCIPAL EXECUTIVE `? t v <br /> <br />TYPED OR PRINTED e <br />r <br />m <br />orma <br />an. <br />ne <br />se m <br />d <br />ih <br />l <br />h OFFICER OR AUTHORIZED AGENT AREA <br /> nc <br />r pass <br />il,t ,„ ., n ., t.. ,i v (x t „ w Ing vl lanon, <br />u <br />ng t CODE NUMBER YEAR MO <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />MPLE <br />TYPE <br />DAY <br /> <br />EPA Form 3320-1 (Rev. 3199) Previous eddtons may be used. This is d 4-Part fonn. PAGE