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PERMITTEE NAME/ADDRESS,tnrfudc Fecifir, %am,rl..,car r fn p-ii <br />NAME <br />ADDRESS <br />FACILITY <br />LOCATION <br /> <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 />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 />MEASUR <br />T <br />M ,t <br /> E <br />EN <br /> PERMIT - ;_ r., . ... . <br /> REQUIREMENT P•1Gi',i' ' <br /> SAMPLE <br />MEA f <br />III' <br /> SUREMENT <br /> PERMIT a r <br /> REQUIREMENT i?if'v•Jr <br /> SAMPLE <br />MEASUREMENT <br /> <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />MEASUREMENT ` <br /> <br /> PERMIT .- <br /> REQUIREMENT <br /> SAMPLE <br />MEASUREMENT' <br /> <br /> PERMIT t <br /> REQUIREMENT IJf;t =. <br /> SAMPLE <br />A <br />R <br />M <br />`- <br /> ME <br />SU <br />E <br />ENT <br /> PERMIT - <br /> REQUIREMENT L ._.i•.t •.. ';- <br /> SAMPLE <br />N 1 <br />(- .A P <br /> MEASUREME <br />T <br /> PERMIT <br /> REQUIREMENT <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER I.'emir. under la•nalt.v of law that thi%d-ument and all attachment%were <br />prepared under nn direction or w <br />cr.i%ion in acconhace with a -tern deigned TELEPHONE DATE <br /> p - <br />' L;w <br />• <br />? to awurr thou ,li lifted personnel pnga•rlh µther and ev,duale the information <br />h <br />f the <br />a <br />tnd <br />Rau-d - <br />in <br />uir <br />• <br />, <br />n <br />er <br />n% wh <br />ana <br />th <br />• <br />-l <br />?, , <br />. <br />?. _ . <br />- u <br />nu <br />. <br />my <br />q <br />y o <br />ln <br />rs <br />m <br />r p <br />.u <br />o n <br />gc <br />a <br />? <br />em. <br />- or th,we per%,w, dimtlc re,pm.ible for gathering the mfarnalion. the infornation <br />- whmuted i., to the bmt of mi km,wledge and helief. tnte. accurate, and complete. <br />f <br /> I um aware that them am ognifa:ant <br />enaltie+ fur ubmilunK faly infurnution SIGNATURE OF PRINCIPAL EXECUTIVE <br />- <br /> , <br />p OFFICER OR AUTHORIZED AGENT AREA <br />TYPED OR PRINTED including the p-ibilih of fine and impriconmem ror knowing vinlationc, 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. This is a 4-part fern.