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PERMITTEE NAME/ADDRESSpweirFoe+MryNw?L«rie.t/D?irrwuj <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />NATIONAL POLLUTANT DISCHARGE EUMINATION SYSTEM NPDES) <br />DISCHARGE MONITORING REPORT ID R) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved <br />OMB No 2040-0004 <br /> <br />NOTE: Road lil•tructlone before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREOUENCY SAMPLE <br /> of <br /> EX ANALYSIS TYPE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> <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 /> <br /> PERMIT <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br />PERMIT <br />REQUIREMENT <br />1 Z;Mlr Y er Pena ly O law that IhN dorumtnt and all attachments were NAME/TITLE PRINCIPAL EXECUTIVE OFFICER <br />TELEPHONE <br />4 DATE <br />Prepared under my di ectlon or mpe, <br />on In accordance with ¦ system deftnee <br />to assure that ti-MI'led personne+ property lather and evaluate the information <br />submitted. Sward on my Inquiry of the person or persons who manase the system, <br />or those person directly nesponible for gathering the Information, the Information <br />--- submitted N, to the best of my knowledge and bellef• 1ror. accurate, and complete. <br />Nf4ar! <br />r^ <br />1 am aware that there an s1 <br />a!!tv !-, submittin <br />rst.:SIGNATURE OF PRINCIPAL EXECUTIVE <br /> i <br />? <br />. <br />g AREA <br />TYPED OR PRINTED Imludlrg the posalbllly or fine ¦nd impnsnnmrnt nor knowlnr 0o1.0- OFFICER OR AUTHORIZED AGENT ODE NUMEIER <br />C YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference oN attachments hore) <br />Jr, - ^r, Tr?. I MT APP'`I II-!) Ff7R `,,? n.I ppx r?.? <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used This is a 4-part fOnn. PAGE OF