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PERMITTEE NAME/AODRESSp"F.rWgN?.dLe?.rlaw(/D?i.wv) <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />NATIONAL POLLUTANT 04SCHAROE ELIMINATION SYSTEM fWDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER aNUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved <br />I nlr• OMB No 2040-0004 <br />NOTE: Read k»tme0oM before eomnletMa thia fnrm <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FAEOUENCY <br />OF SAMPLE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT T+";i i <br /> SAMPLE <br />MEASUREMENT <br />h {' <br /> <br /> PERMIT <br /> REQUIREMENT f <br /> SAMPLE <br />MEASUREMENT <br />L <br /> <br /> PERMIT <br /> <br /> REQUIREMENT - ` - <br /> <br />`R, SAMPLE <br />MEASUREMENT - <br />1 ' <br /> . <br /> PERMIT <br /> REQUIREMENT !- <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> <br />- - <br />REQUIREMENT T i' r 'if? <br /> 'A L- <br /> SAMPLE <br />MEASUREM <br /> ENT - <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> <br /> REQUIREMENT <br />NAMEfnTLE PRIN PAL EXECUTIVE OFFICER ' P`"•'? ° 1i- Ih?l this documenl and au allwhm entf were <br /> <br />Prepared under my dincllon or auyer <br />rilon In wcorda- with a <br />f <br />fl <br />y <br />i <br />d <br />d TELEPHONE <br />T <br /> <br />?r . <br />I <br />I 7 <br />e <br />n <br />e <br />gne <br />to uwre that quaHfled <br />ersonn <br />l <br />r <br />ath <br />t _ <br />' DA <br />E <br />F ( <br />? <br />y <br />1 <br />I(_y( / _ <br />`- <br />- p <br />e <br />P <br />oper <br />y g <br />er and evaluate The Infoerrullon <br />tubmlllyd. Bawd on my Inquiry of the <br />per7oa or perawu who manage the frftem, <br />or those Danom directly refPoral bk row tatherin the I.formall <br />t on, the In/orma(Mn <br />susid 6 <br />so the best of rn ,- <br />/ <br />? - .? ? ? ? ? ?? j . <br />j - <br /> <br /> <br />?l ' I :/1 <br /> <br />r <br />/ <br />V <br /> <br />, <br />y ..... Ihat the on <br />I <br />nificant <br />enealnes f <br />b <br />r <br />a <br />g <br /> <br />/ 1e.' I r <br />OR PRIN <br />ED g <br />P <br />or m <br />m <br />Tnn <br />r <br />ise Infonna ion. <br />l <br />di <br />l SIGNATURE OF PRINCIPAL EXECUTIVE <br />TYPED <br />T fc <br />u <br />ng the Possibility of Ron, and Imprtaonm+em row Lno.ing .1e1.IbTn OFFICER OR AUTHORIZED AGENT AAFA HUMBER <br /> YEAR MO OAY <br />COMMENTS AND EXPLANATION OF ANY VIOL ATIONS (Reference eM efhchnlentt h-I <br />'NL.Y 11' - ic:Ylt, c?ntiH t RECIP EVENT IS CLAIMED. IF CLAIM APPRO'..'E) 13Y WOCD? <br />±lrr -rr p> n(lR?T r hr':.,° 1,CMy.-rT-1. c- r. I T 1 n. <br />EPA Form 3320-1 (Rev 3/99) Previous editions may be used This is a 4-part fornl. PAGE OF