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PERMITTEE NAME/ADDRESS tlndudr fardm Natae, ,uu„n .1 htp,-11 <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM NPDES) <br />DISCHARGE MONITORING REPORT (D 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 />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. <br /> <br />EX FREQUENCY <br />OF SAMPLE <br /> <br />TYPE <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 /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT _ l <br /> REQUIREMENT <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certify under prnalo of law that chi, d,a-umrmt and all anarhmenls were <br />- TELEPHONE DATE <br /> prepared under my dirmlion or uprrvi,ion in accordance with a svctem de <br />igwd <br /> to assure that qualified per onnel ProP•rli gather and esahrate the information <br /> submitted. Bard on my inquire or the I-n or pervm, who manage the system. _ <br /> or Ih- persons dirmdy responsible for gathering the information, the information <br /> and com <br />d is <br />to the lust or m. knawled <br />:md heief <br />tore <br />accurair <br />lete <br />h <br />itt <br /> , <br />. <br />, <br />p <br />. <br />su <br />m <br />e <br />ge <br />. SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br /> <br />TYPED OR PRINTED <br />F I am aware that them am signirwant penaltit, for suhmitting fate information. <br /> <br />including the pc-ihilitr or fine And imprisonment for knowing violation. <br /> <br />OFFICER OR AUTHORIZED AGENT AREA <br /> <br />D NUMBER <br />CO <br /> <br />YEAR <br /> <br />MO <br /> <br />DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />J0,11 T A F2 <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. This is a 4-part form.