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PERMITTEE NAME/ADDRESS (Include Facility vanve/burat un q mip,mlI <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 /> <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. <br /> <br />EX FREQUENCY <br />OF SAMPLE <br /> <br />TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />7) l ^ <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 cerlift under renal) )'law that thisdeeevmeni and All,dnwrhneents were <br />i <br />with <br />yst <br />d <br />i <br />d <br />i <br />i <br />i <br />i <br />d <br />d <br />+- TELEPHONE DATE <br /> rect <br />on or surxrs <br />ance <br />a s <br />em <br />es <br />gne <br />prepare <br />tinder np d <br />s <br />on <br />n accor - <br />- <br />l ` ?l) to assure that yuulireeed pervennel propene gather and r alunle the mr 1 Lion <br />i <br />of th <br />er )n o <br />w ho mana <br />e the ste <br />b <br />it <br />d <br />n <br />i <br />t <br />rwi <br />N <br />d _ <br />V m <br />on <br />n <br />n <br />lu <br />n <br />e p <br />r pe <br />ns <br />g <br />m. <br />m <br />u <br />. <br />a- <br />s or those rw,ons der d responsibly for galhcnng the m(ornulion, the information <br />t- - xccurule. and tnmpkle <br />submitted i. <br />to the M <br />t of rat knowledge and 1"Irf <br />true <br />_ <br />?- ` , <br />, <br />. <br />. <br />.. <br />i <br />r <br />i <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br /> un, <br />I am aware that there are significant penalties fur submitting fuke <br />n <br />ormat FFI <br />ER <br />AUTH <br />A <br />N AR <br />TYPED OR PRINTED including the pensihilits or fine and imprimatmeni for knowing siolntions. O <br />OR <br />ORIZED <br />GE <br />T <br />C pE NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />FF ALL. <br />DT F <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. This is a 4-part fon-n.