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PERMITTEENAME!ADDRESSrlnelrekFaciht%-NanwvlwitonrJDillemntl <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 Approvers. <br />OMB No. 2040-0004 <br /> <br />Al <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREDUENCY SAMPLE <br />OF <br /> EX <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br />i <br />SAMPLE <br /> MEASUREMENT <br /> PERMIT _ <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />'i MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ; + _, <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT i-' <br /> REQUIREMENT r` -NTH <br />NAME-`TITLE PRINCIPAL EXECUTIVE OFFICER I ccm;?. under lunaln --f Iaw that this documcnt and all anachments were TELEPHONE DATE <br /> prepared under me dirwian or supenisnn to actor a ce with a system designed <br />- <br /> <br />JAG<f lL- <br />' ?? to .tssure that qualified pcr<onnel prupcrh gather and a uluatc the nlormatmn <br />e the system <br />ersons who mana <br />tt <br />m <br />in <br />uir <br />f the <br />erson or <br />b <br />d B <br />d _- <br />i <br />, g <br />, <br />y <br />q <br />y o <br />p <br />p <br />su <br />mi <br />e <br />ase <br />n <br />or these persons directl} rrspcnsible for gathering the information. the information <br /> l <br />d b <br />t <br />t <br />m <br />l <br />t <br />h <br />k <br />d <br />l <br />f <br />d <br />b <br />l <br />h <br />f <br />_ now <br />rue. accura <br />e. an <br />co <br />p <br />e. <br />mutex <br />is, t.. t <br />est o <br />m} <br />e <br />ge an <br />e <br />ie <br />. <br />e <br />su <br />e SIGNATURE OF PRINCIPAL EXECUTIVE <br /> I am aware that 11wre are s:guificani penalties for suhmnnng take nforrnanon• <br />k <br />l OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER <br />YEAR <br />MO DAY <br />TYPED.-OR PRINTED nowing s,o <br />atioris <br />ncluding the pu-bihl% of title :utd imprisonment for CODE <br />COMMENTS AND EXPLANATION OF ANY <br />(Rererence an attacnments nere) <br />aMF <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. Y • Tbis is a 4-pate form. PAGE OF