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i PERMITTEE NAME/ADDRESS rlnehideFueiLm <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <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 />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> <br />EX OF <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT r i ` T <br />_ I . I. REQUIREMENT - rlh= <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT X iI <br /> SAMPLE <br />r, cr MEASUREMENT <br /> PERMIT ; .. 1:• : %ti: _ . <br />- REQUIREMENT r.`:' _• ^'1 ',; f.: r,. , - ., <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT z r- <br />l?i ( - REQUIREMENT ;•.., <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT W I C: T.../ •'s'A f' <br /> REQUIREMENT PTU?IT`' <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT ;.. , . t: iNT I .. <br /> REQUIREMENT <br />SAMPLE <br />MEASUREMENT <br />PERMIT --F'f?R i :Fif Ia`,_ `• F?IV <br />REQUIREMENT I <br />NAMEfnTLE PRINCIPAL EXECUTIVE OFFICER I <crnf., under penalh' of law th.n all anachinem. ccrc <br />ith <br />i <br />d <br />d <br />di <br />t <br />d <br />d <br />d TELEPHONE DATE <br />/ <br />Sf c H (? e= ;LTA t!" prepare <br />ance w <br />a s:, <br />cm <br />e,ipe <br />un <br />er my <br />rec <br />ion or supcn i iw" m accor <br />to assure that qualified rwr.,onncl properly gather and cvahmte the mlonnaunn <br /> submitted Ba_+ed on my inquiry of the Ixrson or person. who manage tltc,yctem. ?•% <br /> or those persons directly nspoLuble tar gathenng the information. the ml'"nation , <br />C it I [ , r submitted is. to the best of my kno,icdgc and heltcf. true, accurate, and contplcte. <br />ntficaw <br />analtie? for submitting false information <br />1 am aware that there arc si SIGNATURE OF PRINCIPAL EXECUTIVE - L C? 7 <br /> i <br />g <br />. OFFICER OR AUTHORIZED AGENT AREA <br />TYPED OR PRINTED including the pussibdip of fine .ua: copn.urmem for knowing st.danon`. CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />.7, h1F L I <br />EPA Form 3320"1 (Rev. 3/99) Previous editions may be used. 00 14 1 This is a 4,prt form.