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PERMITTEE NAME/ADDRESS rlnrlude Facifitn ?umca-u<an, n ii h i/.r rr <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />I <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 />ROUTT <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NQ" FREQUENCY SAMPLE <br /> <br />EX OF <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 /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER I rertifs under 1-alts „f In% that this cl-ooreat and all atiaohmenis were <br />ers ision in aerordunu with a <br />re <br />ared under ms dirai•tion or su <br />%trn, cl i$:nrd <br />- ' TELEPHONE DATE <br /> p <br />p <br />p <br />% <br /> to assure that qualified pemonnd prnperts Rather and rsaluale ttw information <br />submitted. Raid on mi inquirs of the person or persons ,fin manage the sselem. _ <br /> or thus' pet-,o , dimrtlt resla,nsible for gathering the information, the information <br />- submitted is <br />to the bed of ms knowledge and belief <br />true <br />accurate <br />and rnmplete <br /> . <br />, <br />, <br />. <br />, <br />fo <br />h <br />itti <br />I <br />w <br />r <br />that th <br />e <br />si <br />nific <br />nt <br />a <br />uttie <br />f <br />l <br />e i <br />fo <br />atio <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br /> , <br />am a <br />a <br />e <br />er <br />are <br />g <br />a <br />l <br />n <br />r su <br />nt <br />ng <br />a <br />s <br />n <br />rm <br />n, OFFICER OR AUTHORIZED AGENT AREA <br />TYPED OR PRINTED indudint , the pn,<ibilits of fine and imprisonment for km,wing iolatiuns. CODE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. 70' Thisis?a 4-part form.