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PERMITTEE NAMEIADDRESS +I 6.dr ha. ,::n ?•»:? 1..:........ :±OtJTFnno <br />NAME <br />ADDRESS <br />FACILITY <br />i OCATION <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 Approved. <br />OMB No. 2040-0004 <br />X <br />NOTE: Read Instructions before" completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT , <br /> REQUIREMENT .. <br />i SAMPLE <br />- <br />_ MEASUREMENT <br /> PERMIT r l .7EP'UF,: <br /> REQUIREMENT <br /> SAMPLE <br />?. MEASUREMENT <br /> PERMIT _ t. <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 />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER : co;d. under penalt:, of law that this document and all attaehmenLs were TELEPHONE DATE <br /> prepared under my di rection or supen•iston to accordance with a system designed <br />SC tN ( <br />r . . <br />' to assure that quahfed personnel properly gather and evaluate the information <br />h <br />d <br />R <br />l <br />h <br />y -7 <br />" <br />- <br />? <br />• o manage t <br />e system. <br />:ubnmtte <br />. <br />aax <br />on my inquir <br />of the person or persons w r:?•?-fir <br />_ <br /> or those persons directly tesponstble for gathering the information. the mf rimnon <br />C, t submitted is. it, the best of my know ledge and belief, true, accurate. and a+mpletr. <br />i <br />f <br />f SIGNATURE OF PRINCIPAL EXECUTIVE J <br />` <br /> alse informat <br />I am aware that there are silmificant penalties <br />or submuting <br />on, <br />h <br />f fi <br />f <br />l OFFICER OR AUTHORIZED AGENT AREA <br />NUMBER YEAR MO DAY <br />TYPED OA PRINTED n :: <br />or know ng rin <br />auaos. <br />mcludmg the pusih+ <br />ne and imprisonment CODE <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />EPA Form 3320-1 (Rev. 3199) Previous edrtiors may be used. 00014 This js,a 4-part fomi.