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PERMITTEE NAME/ADDRESS Include Fardlt %,,e 1, „n,w it nifJ rrnr <br />NAME <br />ADDRESS <br />Ij <br />FACILITY i <br />LOCATION <br />:i <br />L,1`1L <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 <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE t + l? Irk " t ?I <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> <br /> SAMPLE ?. 1 ?( } ',? ? <br /> MEASUREMENT <br /> PERMIT r : ., .. <br /> REQUIREMENT V'i, r'. ', <br /> SAMPLE <br />- <br /> MEASUREMENT <br /> PERMIT i ?:.. <br /> REQUIREMENT e <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT . _ i - :. • , <br /> REQUIREMENT <br /> SAMPLE / <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br />/ <br />I 1? <br />I <br /> 14L z` r <br /> MEASUREMENT <br /> <br />PERMIT - - n - - s.. L_ 1 .... <br /> REQUIREMENT <br />NAMEMTLE PRINCIPAL EXECUTIVE OFFICER I 'emir- under penult ul law that lhlslloeume•nt and all attachments were, TELEPHONE DATE <br /> prepurrd under m% dine Linn o - -I.- siun in xcurdance with a ,'stem designed - <br /> <br />m( rmuliun <br />to.satre that qualified pe-umel pre p-1, gather and et.Mule the <br />who mana <br />f th <br />w <br />r <br />m <br />th <br />st <br />m <br />b <br />i <br />R <br />d <br />• <br />'_ - <br />- <br />1 e p <br />r <br />rn o <br />perv <br />. <br />ge <br />e , <br />e <br />. <br />w <br />m <br />tlyd. <br />ase <br />on me nulwrv ? . .- - <br /> ur throe perwns dirre•lle t espm. d 1 fur galhermg the information the mf,rmution <br /> submit led is. la the heI or me knowledge and hebef. Irue. accurate, and eom plele. <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br /> <br />a <br />?- <br />TYPED OR PRINTED 1 am aware that there are ignifn•ant penalties for ,.uhmnting fal.e infurmanun. <br />including the p^d dlt or fine and impri nmrnl fur knowing " i'lations. OFFICER OR AUTHORIZED AGENT AREA NUMBER YEAR MO DAY <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here) <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. " 'C' Thi,. is A 4-pArt form.