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PERMITTEE NAME/ADDRESS,hlrlude Furthn \unulhnalion q hif(Ivrtu. <br />NAME <br />ADDRESS dL <br />FACILITY <br />LOCATION <br />Ef4G I t,;EEF <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (OMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />FROM YEAR MO DAY TO YEAR MO DAY <br />Form Approved <br />OMB No. 2040.0004 <br />r <br />NOTE: Read Instructions hefnrP rmmnIptino this form- <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO• FREQUENCY 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 /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> <br /> MEASUREMENT <br /> i. <br /> PERMIT 1 <br /> REQUIREMENT / <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT '+- <br /> REQUIREMENT i? <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 />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I aenif} under pcnull. of lax Ihm uli. docllmem:Ine:lu atwah...... rrr TELEPHONE DATE <br /> preparvd under m. Jirarnort or ... in .-.,rd:mee ..ith a ... w., de.lf;nd <br />. <br /> 16:d.uahrird x"r.oanrl ri. <br />1 1 P pt•"11 .}:al her .uul r. ulmlr lhr in G.rmulinn <br />• " Illllrt llll'll. I{:I.fJ nl til. Illi(1111'\ If IIII' (Mi?m ..f (n•r.on. <br />l <br />-? <br /> or Ihu.a• (k'ron. dirt. d. re.p.•n.iblr for ;;eUn"rhl? Ule informnuun. Ihr inLa ma/lon .? <br />-- ' <br />` <br />'?' --- - - --'? -- a <br />' <br /> <br />muhmiuaal n. In tin• br.l .f m. I.noairdge and lu"IieL true. dreur lr. and u.mpkle. <br />1 am -l" Itwl that are ignif-l-ni <br />-0 14, hm -6.miim <br />f:dk mforn <br />lio <br /> <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />j '? ` ll <br />i ) <br />J J ?? - / <br /> <br />- <br />TYPED OR PRINTED 1 <br />R <br />w <br />n. <br />imhldln_ we p -ihdil. .( riw•.md impri?onmenl for k -ing.iotulion., OFFICER OR AUTHORIZED AGENT AREA NUMBER YEAR MO <br />D <br /> CODE AY <br />TO TH.' <br />EPA Form 3320-1 (Rev T99) Previous editions may be used. 0004E Ti t j.? 4_ratY-4inn.